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 Journal Article
| Authors: | Konstantinidis, I. T.; Do, R. K. G.; Gultekin, D. H.; Gonen, 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. |
| Article Title: | 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 |
| 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. © 2014 Society of Surgical Oncology. |
| Keywords: | adult; cancer chemotherapy; cancer survival; clinical article; controlled study; treatment outcome; cancer surgery; overall survival; disease course; bevacizumab; fluorouracil; cancer combination chemotherapy; drug dose reduction; drug safety; treatment duration; gemcitabine; cancer radiotherapy; gadolinium; nuclear magnetic resonance imaging; follow up; cancer grading; progression free survival; computer assisted tomography; tumor volume; lung resection; ca 19-9 antigen; carcinoembryonic antigen; tumor differentiation; dexamethasone; continuous infusion; retrospective study; irinotecan; aspartate aminotransferase blood level; postoperative complication; alkaline phosphatase; aspartate aminotransferase; bilirubin; contrast enhancement; long term care; heparin; liver resection; bile duct carcinoma; alkaline phosphatase blood level; external beam radiotherapy; drug administration; oxaliplatin; radiofrequency ablation; floxuridine; wound infection; bilirubin blood level; disease specific survival; supraventricular tachycardia; cellulitis; nuclear magnetic resonance scanner; hepatic arterial infusion; phase 2 clinical trial (topic); gadolinium pentetate meglumine; named inventories, questionnaires and rating scales; acute pancreatitis; response evaluation criteria in solid tumors; dynamic contrast enhanced magnetic resonance imaging; time to treatment; human; male; female; article |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 21 |
| Issue: | 8 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2014-08-01 |
| Start Page: | 2675 |
| End Page: | 2683 |
| Language: | English |
| DOI: | 10.1245/s10434-014-3649-y |
| PROVIDER: | scopus |
| PUBMED: | 24664624 |
| PMCID: | PMC4516216 |
| DOI/URL: | |
| Notes: | Export Date: 2 September 2014 -- CODEN: ASONF -- Source: Scopus |
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