PMID- 17851723
OWN - NLM
STAT- MEDLINE
DCOM- 20080520
LR  - 20240213
IS  - 1091-255X (Print)
IS  - 1091-255X (Linking)
VI  - 12
IP  - 1
DP  - 2008 Jan
TI  - Treatment of unresectable cholangiocarcinoma with gemcitabine-based transcatheter 
      arterial chemoembolization (TACE): a single-institution experience.
PG  - 129-37
AB  - BACKGROUND: Survival for patients with unresectable cholangiocarcinoma is 
      reported to range from only 5-8 months without treatment. Systemic chemotherapy 
      has not been shown to significantly improve survival, but newer regimens 
      involving gemcitabine have shown increased response rates. Transcatheter arterial 
      chemoembolization (TACE) has been shown to prolong survival in hepatocellular 
      carcinoma patients, but experience using TACE in the treatment of 
      cholangiocarcinoma is limited. We report our experience treating 
      cholangiocarcinoma with TACE using chemotherapeutic regimens based on the 
      well-tolerated drug gemcitabine. METHODS: Forty-two patients with unresectable 
      cholangiocarcinoma were treated with one or more cycles of gemcitabine-based TACE 
      at our institution. Chemotherapy regimens used for TACE included: gemcitabine 
      only (n=18), gemcitabine followed by cisplatin (n=2), gemcitabine followed by 
      oxaliplatin (n=4), gemcitabine and cisplatin in combination (n=14), and 
      gemcitabine and cisplatin followed by oxaliplatin (n=4). RESULTS: Patients were 
      59 years of age (range 36-86) and received a median of 3.5 TACE treatments (range 
      1-16). Thirty-seven patients (88%) had central cholangiocarcinoma, and five (12%) 
      had peripheral tumors. Nineteen patients (45%) had extrahepatic disease. Grade 3 
      adverse events (AEs) after TACE treatments were seen in five patients, whereas 
      grade 4 AEs occurred in two patients. No patients died within 30 days of TACE. 
      Median survival from time of first treatment was 9.1 months overall. Results did 
      not vary by patient age, sex, size of largest initial tumor, or by the presence 
      of extra-hepatic disease. Treatment with gemcitabine-cisplatin combination TACE 
      resulted in significantly longer survival (13.8 months) compared to TACE with 
      gemcitabine alone (6.3 months). CONCLUSIONS: Our report represents the largest 
      series to date regarding hepatic-artery-directed therapy for unresectable 
      cholangiocarcinoma and provides evidence in favor of TACE as a promising 
      treatment modality in unresectable cholangiocarcinoma. Our results suggest that 
      gemcitabine-based TACE is well tolerated and confers better survival when given 
      in combination therapy (with cisplatin or oxaliplatin) for patients with 
      unresectable cholangiocarcinoma.
FAU - Gusani, Niraj J
AU  - Gusani NJ
AD  - Division of Surgical Oncology, Department of Surgery, University of Pittsburgh 
      Medical Center, Pittsburgh, PA 15213, USA.
FAU - Balaa, Fady K
AU  - Balaa FK
FAU - Steel, Jennifer L
AU  - Steel JL
FAU - Geller, David A
AU  - Geller DA
FAU - Marsh, J Wallis
AU  - Marsh JW
FAU - Zajko, Albert B
AU  - Zajko AB
FAU - Carr, Brian I
AU  - Carr BI
FAU - Gamblin, T Clark
AU  - Gamblin TC
LA  - eng
GR  - K12 HD049109/HD/NICHD NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20070911
PL  - Netherlands
TA  - J Gastrointest Surg
JT  - Journal of gastrointestinal surgery : official journal of the Society for Surgery 
      of the Alimentary Tract
JID - 9706084
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Organoplatinum Compounds)
RN  - 04ZR38536J (Oxaliplatin)
RN  - 0W860991D6 (Deoxycytidine)
RN  - EC 1.17.4.- (Ribonucleotide Reductases)
RN  - Q20Q21Q62J (Cisplatin)
RN  - 0 (Gemcitabine)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antineoplastic Agents/*administration & dosage
MH  - Bile Duct Neoplasms/diagnosis/mortality/*therapy
MH  - *Bile Ducts, Intrahepatic
MH  - Biopsy
MH  - Chemoembolization, Therapeutic/*methods
MH  - Cholangiocarcinoma/diagnosis/mortality/*therapy
MH  - Cholangiopancreatography, Endoscopic Retrograde
MH  - Cisplatin/administration & dosage
MH  - Contraindications
MH  - Deoxycytidine/administration & dosage/*analogs & derivatives
MH  - Drug Therapy, Combination
MH  - Female
MH  - Follow-Up Studies
MH  - *Hepatectomy
MH  - Hepatic Artery
MH  - Humans
MH  - Injections, Intra-Arterial
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Staging
MH  - Organoplatinum Compounds/administration & dosage
MH  - Oxaliplatin
MH  - Retrospective Studies
MH  - Ribonucleotide Reductases/antagonists & inhibitors
MH  - Survival Rate
MH  - Time Factors
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
MH  - Gemcitabine
EDAT- 2007/09/14 09:00
MHDA- 2008/05/21 09:00
CRDT- 2007/09/14 09:00
PHST- 2007/05/31 00:00 [received]
PHST- 2007/08/16 00:00 [accepted]
PHST- 2007/09/14 09:00 [pubmed]
PHST- 2008/05/21 09:00 [medline]
PHST- 2007/09/14 09:00 [entrez]
AID - S1091-255X(23)08151-9 [pii]
AID - 10.1007/s11605-007-0312-y [doi]
PST - ppublish
SO  - J Gastrointest Surg. 2008 Jan;12(1):129-37. doi: 10.1007/s11605-007-0312-y. Epub 
      2007 Sep 11.