Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2019; 11(6): 489-498
Published online Jun 15, 2019. doi: 10.4251/wjgo.v11.i6.489
Clinical efficacy of gemcitabine and cisplatin-based transcatheter arterial chemoembolization combined with radiotherapy in hilar cholangiocarcinoma
Wen-Heng Zheng, Tao Yu, Ya-Hong Luo, Ying Wang, Ye-Fu Liu, Xiang-Dong Hua, Jie Lin, Zuo-Hong Ma, Fu-Lu Ai, Tian-Lu Wang
Wen-Heng Zheng, Tao Yu, Ya-Hong Luo, Ying Wang, Department of Medical Imaging, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
Ye-Fu Liu, Xiang-Dong Hua, Zuo-Hong Ma, Department of Hepatobiliary and Pancreatic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
Jie Lin, Fu-Lu Ai, Department of General Surgery (VIP ward), Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
Tian-Lu Wang, Department of Radiotherapy, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
Author contributions: Zheng WH was responsible for study design, data collection and analysis, and manuscript writing and proofreading; Yu T was responsible for study design and manuscript writing and proofreading; Luo YH and Wang Y performing the research and data analysis; Liu YF, Hua XD, and Lin J performed data collection and proofreading; Ma ZH, Ai FL, and Wang TL performed data analysis.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the Liaoning Cancer Hospital.
Informed consent statement: Informed consent was waived by the Institutional Review Board of the Liaoning Cancer Hospital because this study is a retrospective study.
Conflict-of-interest statement: None of the authors has any conflict of interest.
STROBE statement: The STROBE of checklist items has been included in the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tao Yu, MD, PhD, Chief Doctor, Department of Medical Imaging, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, No. 44, Xiaoheyan Road, Dadong District, Shenyang 110042, Liaoning Province, China. yutao@cancerhosp-ln-cmu.com
Telephone: +86-18900917557 Fax: +86-24-24315679
Received: March 7, 2019
Peer-review started: March 8, 2019
First decision: May 13, 2019
Revised: May 15, 2019
Accepted: May 28, 2019
Article in press: May 29, 2019
Published online: June 15, 2019
Abstract
BACKGROUND

Radical surgical resection is regarded as the best treatment for hepatic hilar cholangiocarcinoma. However, 60%-70% of patients have lost the chance of surgery at the time of diagnosis. Simple biliary stent or drainage tube placement may fail in a short time due to tumor invasion or overgrowth, bile accumulation, or biofilm formation. Effective palliative treatments to extend the effective drainage time are of great significance for improving the quality of life of patients and changing the prognosis of patients.

AIM

To investigate the clinical efficacy of gemcitabine and cisplatin-based transcatheter arterial chemoembolization (TACE) combined with radiotherapy in hilar cholangiocarcinoma.

METHODS

A retrospective analysis was conducted on patients clinically diagnosed with hilar cholangiocarcinoma from June 2014 to January 2017 at the Liaoning Provincial Cancer Hospital. Patients were evaluated by specialists, and those who were not suitable for surgery or unwilling to undergo surgery and met the inclusion criteria were included in the study. There were a total of 72 patients (34 males and 38 females) with an average age of 59.9 years (range, 40-72 years). According to percutaneous transhepatic biliary angiography and the patients’ wishes, stent implantation or biliary drainage tube implantation was used to relieve biliary obstruction. The patients were divided into either a control group or a combined treatment group according to their follow-up treatment. The control group consisted of a total of 35 patients who received simple biliary drainage tube placement and biliary stent implantation (7 patients with bilateral stents and 6 with a unilateral stent) and 22 patients receiving biliary drainage tube placement alone. The combined treatment group received TACE and extracorporeal radiotherapy after biliary drainage or biliary stent implantation and consisted of a total of 37 patients, including 21 patients receiving combined treatment after biliary stent placement (14 patients with bilateral stents and 7 with a unilateral stent) and 16 undergoing combined therapy after implanting the biliary drainage tube. In the combination treatment group, the TACE chemotherapy regimen employed gemcitabine and cisplatin, and the embolic agent was iodized oil. A particular dose was determined according to the patient's body surface area and the tumor staining indicated by DSA. In vitro radiotherapy was performed with intensity-modulated radiotherapy or three-dimensional conformal radiotherapy at an average dose of 48.3 Gy. Both groups were followed from stent implantation or drainage tube implantation until the patient quitted or died. The median length of follow-up observation was 13 mo. The differences in overall survival time and the effect of different jaundice reducing methods (single stent, double stent, or biliary drainage) on the patency time and survival time of biliary stents were compared between the two groups; the related factors affecting overall survival time were analyzed.

RESULTS

The median survival time of the control group was 10.5 mo; the median survival time of patients with biliary stent implantation and those with percutaneous biliary drainage was 9.6 mo and 11.4 mo, respectively, and there was no statistically significant difference between them. The median survival time of the combined treatment group was 20.0 mo, which was significantly higher than that of the control group (P < 0.05). Among patients in the combined treatment group, the median survival time of patients who underwent biliary stent implantation and those who accepted percutaneous biliary drainage before the combination therapy was 19.5 mo and 20.1 mo, respectively, and there was no significant difference between them. In the combination treatment group, the mean time of median stent patency was 15.6 mo, which was significantly higher than that of the control group (7.0 mo; P < 0.05). The independent factors affecting survival time included age, whether to receive combination therapy, percutaneous biliary drainage tube implantation, and Bismuth-Corlette classification as type IV.

CONCLUSION

Gemcitabine and cisplatin-based TACE combined with radiotherapy can prolong the survival of patients with hilar cholangiocarcinoma. Independent predictors of survival include selection of combination therapy, Bismuth-Corlette classification as type IV, selection of percutaneous biliary drainage tube implantation, and age.

Keywords: Hilar cholangiocarcinoma, Biliary stent, Percutaneous biliary drainage, Gemcitabine, Cisplatin, Radiotherapy, Transcatheter arterial chemoembolization

Core tip: In this study, hilar cholangiocarcinoma patients with obstructive jaundice were observed by different methods of reducing jaundice. The effectiveness of transcatheter arterial chemoembolization combined with radiotherapy was observed in extending the effective drainage time of the stent or drainage tube, improving the quality of life, and changing the prognosis of patients. The independent factors affecting survival were analyzed. The results may be helpful to improve the systematic palliative treatment of hilar cholangiocarcinoma.