Meta-Analysis Offers Convincing Evidence for use of RFA in Treatment of Unresectable Intrahepatic Cholangiocarcinoma

While surgery with negative resection margins is known to be the only curative treatment option for intrahepatic cholangiocarcinom, most patients are not candidates for curative resection because of advanced stage at the time of initial presentation. Increasingly, radiofrequency ablation has been used in the treatment of hepatic tumors. However, a relatively small amount of research has been performed on this treatment method in this patient population.

The purpose of this study was to perform a meta-analysis and systematic review of the clinical efficacy and safety of radiofrequency ablation in the treatment of intrahepatic cholangiocarcinoma. Authors collected data from Ovid MEDLINE and EMBASE database. Seven out of 144 articles comprising 84 total patients were selected based on strict exclusion criteria. Technical success rate for radiofrequency ablation ranges from 66-100 % with different approaches like ultrasound guided with conscious sedation or intraoperative with general anesthesia. The pooled 1-year, 3-year, and 5-year survival rates were 82% (95% CI, 72%–90%), 47%(95% CI, 28%–65%), and 24% (95% CI, 11%–40%) respectively. While the overall median survival is superior when compared with other arterial-based locoregional therapies, comparison is difficult given a significantly decreased incidence of extrahepatic disease in the present analysis.

Comment:

The present study offers positive data that RFA may be offered in patients with intrahepatic cholangiocarcinoma. While to the interventionalist, it may seem self-evident that RFA would aid in local tumor control in this patient population, this article will aid in the multi-disciplinary setting to demonstrate efficacy and increased use in this difficult patient population. With additional research into ideal ablative technology and factors predictive of recurrence (location, size, grade, etc.) this procedure will become increasingly utilized in the future.


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Citation: Han, K. et al. Radiofrequency Ablation in the Treatment of Unresectable Intrahepatic Cholangiocarcinoma: Systematic Review and Meta-Analysis. Journal of Vascular and Interventional Radiology 26, 943–948 (2015).


Author: Ali Rahmat, MD. Yale University Radiology Resident.