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01-08-2014 | Hepatobiliary Tumors

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

Authors: Ioannis T. Konstantinidis, MD, Richard K. G. Do, MD, David H. Gultekin, PhD, Mithat Gönen, PhD, Lawrence H. Schwartz, MD, Yuman Fong, MD, Peter J. Allen, MD, Michael I. D’Angelica, MD, Ronald P. DeMatteo, MD, David S. Klimstra, MD, Nancy E. Kemeny, MD, William R. Jarnagin, MD

Published in: Annals of Surgical Oncology | Issue 8/2014

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.

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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
Authors: Ioannis T. Konstantinidis, MD
Richard K. G. Do, MD
David H. Gultekin, PhD
Mithat Gönen, PhD
Lawrence H. Schwartz, MD
Yuman Fong, MD
Peter J. Allen, MD
Michael I. D’Angelica, MD
Ronald P. DeMatteo, MD
David S. Klimstra, MD
Nancy E. Kemeny, MD
William R. Jarnagin, MD
Publication date: 01-08-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 8/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3649-y

At a glance: The STEP trials

Springer Medicine

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

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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