Regional chemotherapy for unresectable intrahepatic cholangiocarcinoma: a potential role for dynamic magnetic resonance imaging as an imaging biomarker and a survival update from two prospective clinical trials.
Τίτλος | Regional chemotherapy for unresectable intrahepatic cholangiocarcinoma: a potential role for dynamic magnetic resonance imaging as an imaging biomarker and a survival update from two prospective clinical trials. |
Publication Type | Journal Article |
Year of Publication | 2014 |
Authors | Konstantinidis, I. T., Do R. K. G., Gultekin D. H., Gönen M., Schwartz L. H., Fong Y., Allen P. J., D'Angelica M. I., DeMatteo R. P., Klimstra D. S., Kemeny N. E., & Jarnagin W. R. |
Journal | Ann Surg Oncol |
Volume | 21 |
Issue | 8 |
Pagination | 2675-83 |
Date Published | 2014 Aug |
ISSN | 1534-4681 |
Λέξεις κλειδιά | Antibodies, Monoclonal, Humanized, Antineoplastic Combined Chemotherapy Protocols, Bevacizumab, Bile Duct Neoplasms, Bile Ducts, Intrahepatic, Biomarkers, Tumor, Cholangiocarcinoma, Dexamethasone, Female, Floxuridine, Follow-Up Studies, Humans, Infusions, Intra-Arterial, Magnetic Resonance Imaging, Male, Middle Aged, Neoplasm Staging, Prognosis, Prospective Studies, Retrospective Studies, Survival Rate |
Abstract | BACKGROUND: For patients with unresectable intrahepatic cholangiocarcinoma (ICC), treatment options are limited and survival is poor. This study summarizes the long-term outcome of two previously reported clinical trials using hepatic arterial infusion (HAI) with floxuridine and dexamethasone (with or without bevacizumab) in advanced ICC.METHODS: Prospectively collected clinicopathologic and survival data were retrospectively reviewed. Response was based on Response Evaluation Criteria in Solid Tumors (RECIST). Pre-HAI dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) images were reviewed, and tumor perfusion data correlated with outcome.RESULTS: Forty-four patients were analyzed (floxuridine, 26; floxuridine/bevacizumab, 18). At a median follow-up of 29.3 months, 41 patients had died of disease. Partial response by RECIST was observed in 48 %, and 50 % had stable disease. Three patients underwent resection after response, and 82 % received additional HAI after removal from the trials. Median survival was similar in both trials (floxuridine 29.3 months vs. floxuridine/bevacizumab 28.5 months; p = 0.96). Ten (23 %) patients survived ≥3 years, including 5 (11 %) who survived ≥5 years. Tumor perfusion measured on pre-treatment DCE-MRI [area under the gadolinium concentration curve at 90 and 180 s (AUC90 and AUC180, respectively)] was significantly higher in ≥3-year survivors and was the only factor that distinguished this group from <3-year survivors (mean AUC90 22.6 vs. 15.9 mM s, p = 0.025, and mean AUC180 48.9 vs. 32.3 mM s, p = 0.003, respectively). Median hepatic progression-free survival was longer in ≥3-year survivors (12.9 vs. 9.3 months, respectively; p = 0.008).CONCLUSIONS: HAI chemotherapy can result in prolonged survival in unresectable ICC. Pre-HAI DCE-MRI may predict treatment outcome. |
DOI | 10.1245/s10434-014-3649-y |
Alternate Journal | Ann. Surg. Oncol. |
PubMed ID | 24664624 |
PubMed Central ID | PMC4516216 |
Grant List | P30 CA008748 / CA / NCI NIH HHS / United States P30 CA008748 / CA / NCI NIH HHS / United States |