PDF herunterladen
Endoscopy 2018; 50(08): 751-760
DOI: 10.1055/s-0043-124870
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Efficacy and safety of endoscopic radiofrequency ablation for unresectable extrahepatic cholangiocarcinoma: a randomized trial

Jianfeng Yang   *
1   Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou, China
,
Jing Wang   *
2   Hangzhou Geriatric Hospital, Hangzhou First People’s Hospital Group, Hangzhou, China
,
Haibin Zhou
2   Hangzhou Geriatric Hospital, Hangzhou First People’s Hospital Group, Hangzhou, China
,
Yifeng Zhou
1   Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou, China
,
Yang Wang
1   Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou, China
,
Hangbin Jin
1   Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou, China
,
Qifeng Lou
1   Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou, China
,
Xiaofeng Zhang
1   Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou, China
› InstitutsangabenTRIAL REGISTRATION: Single-center, randomized, prospective trial NCT02592538 at clinicaltrials.gov
Weitere Informationen

Publikationsverlauf

submitted 14. August 2017

accepted after revision 26. November 2017

Publikationsdatum:
17. Januar 2018 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Siehe auch:

Radiofrequency ablation for cholangiocarcinoma: it works, but how?Endoscopy 2018; 50(08): 741-742
DOI: 10.1055/a-0639-5285

Abstract

Background Endoscopic placement of biliary stents to relieve jaundice is the main palliative treatment for unresectable extrahepatic cholangiocarcinoma. Endoscopic biliary radiofrequency ablation (RFA) has been reported to prolong stent patency, which may be beneficial in improving patient survival. However, available evidence is still insufficient, as most reported studies are retrospective case series. The aim of this study was to explore the clinical effect and safety of RFA in patients with unresectable extrahepatic cholangiocarcinoma.

Methods 65 patients with unresectable extrahepatic cholangiocarcinoma, except Bismuth type III and IV hilar cholangiocarcinoma, were enrolled and randomly underwent either RFA combined with biliary stenting (RFA + stent group; n = 32) or biliary stent only (stent-only group; n = 33). Overall survival time, stent patency period, and postoperative adverse events were recorded.

Results In the 21-month follow-up period, the overall mean survival time was significantly longer in the RFA + stent group than in the stent-only group (13.2 ± 0.6 vs. 8.3 ± 0.5 months; P < 0.001). The mean stent patency period of the RFA + stent group was also significantly longer than that of the stent-only group (6.8 vs. 3.4 months; P = 0.02). There was no significant difference in the incidence of postoperative adverse events between the two groups (6.3 % [2/32] vs. 9.1 % [3/33]; P = 0.67).

Conclusion Endoscopic RFA combined with stenting can significantly prolong survival and the stent patency period without increasing the incidence of adverse events in patients with extrahepatic cholangiocarcinoma patient, except Bismuth type III and IV hilar cholangiocarcinoma. This approach can be considered as a safe and effective palliative treatment for these patients.

* These authors contributed equally to this work.


 

  • References

  • 1 Charbel H, Al-Kawas FH. Cholangiocarcinoma: epidemiology, risk factors, pathogenesis, and diagnosis. Curr Gastroenterol Rep 2011; 13: 182-187
    CrossrefPubMedSuche in Google Scholar
  • 2 Razumilava N, Gores GJ. Classification, diagnosis, and management of cholangiocarcinoma. Clin Gastroenterol Hepatol 2013; 11: 13-21
    CrossrefPubMedSuche in Google Scholar
  • 3 Blechacz B, Komuta M, Roskams T. et al. Clinical diagnosis and staging of cholangiocarcinoma. Nat Rev Gastroenterol Hepatol 2011; 8: 512-522
    CrossrefPubMedSuche in Google Scholar
  • 4 Skipworth JR, Olde DSW, Imber C. et al. Review article: surgical, neo-adjuvant and adjuvant management strategies in biliary tract cancer. Aliment Pharmacol Ther 2011; 34: 1063-1078
    CrossrefPubMedSuche in Google Scholar
  • 5 Zografos GN, Farfaras A, Zagouri F. et al. Cholangiocarcinoma: principles and current trends. Hepatobiliary Pancreat Dis Int 2011; 10: 10-20
    CrossrefPubMedSuche in Google Scholar
  • 6 Esnaola NF, Meyer JE, Karachristos A. et al. Evaluation and management of intrahepatic and extrahepatic cholangiocarcinoma. Cancer 2016; 122: 1349-1369
    CrossrefPubMedSuche in Google Scholar
  • 7 Monkemuller K, Popa D, Wilcox CM. Endoscopic treatment options for cholangiocarcinomas. Expert Rev Anticancer Ther 2014; 14: 407-418
    CrossrefPubMedSuche in Google Scholar
  • 8 Groot KB, Fong Y. Outcomes in biliary malignancy. J Surg Oncol 2014; 110: 585-591
    CrossrefPubMedSuche in Google Scholar
  • 9 Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet 2014; 383: 2168-2179
    CrossrefPubMedSuche in Google Scholar
  • 10 Parodi A, Fisher D, Giovannini M. et al. Endoscopic management of hilar cholangiocarcinoma. Nat Rev Gastroenterol Hepatol 2012; 9: 105-112
    CrossrefPubMedSuche in Google Scholar
  • 11 Shariff MI, Khan SA, Westaby D. The palliation of cholangiocarcinoma. Curr Opin Support Palliat Care 2013; 7: 168-174
    CrossrefPubMedSuche in Google Scholar
  • 12 Feng Q, Chi Y, Liu Y. et al. Efficacy and safety of percutaneous radiofrequency ablation versus surgical resection for small hepatocellular carcinoma: a meta-analysis of 23 studies. J Cancer Res Clin Oncol 2015; 141: 1-9
    CrossrefPubMedSuche in Google Scholar
  • 13 Wadsworth CA, Westaby D, Khan SA. Endoscopic radiofrequency ablation for cholangiocarcinoma. Curr Opin Gastroenterol 2013; 29: 305-311
    CrossrefPubMedSuche in Google Scholar
  • 14 Tanguturi SK, Wo JY, Zhu AX. et al. Radiation therapy for liver tumors: ready for inclusion in guidelines. Oncologist 2014; 19: 868-879
    CrossrefPubMedSuche in Google Scholar
  • 15 Han K, Ko HK, Kim KW. et al. Radiofrequency ablation in the treatment of unresectable intrahepatic cholangiocarcinoma: systematic review and meta-analysis. J Vasc Interv Radiol 2015; 26: 943-948
    CrossrefPubMedSuche in Google Scholar
  • 16 Steel AW, Postgate AJ, Khorsandi S. et al. Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction. Gastrointest Endosc 2011; 73: 149-153
    CrossrefPubMedSuche in Google Scholar
  • 17 Laquiere A, Boustiere C, Leblanc S. et al. Safety and feasibility of endoscopic biliary radiofrequency ablation treatment of extrahepatic cholangiocarcinoma. Surg Endosc 2016; 30: 1242-1248
    CrossrefPubMedSuche in Google Scholar
  • 18 Tal AO, Vermehren J, Friedrich-Rust M. et al. Intraductal endoscopic radiofrequency ablation for the treatment of hilar non-resectable malignant bile duct obstruction. World J Gastrointest Endosc 2014; 6: 13-19
    CrossrefPubMedSuche in Google Scholar
  • 19 Zacharoulis D, Lazoura O, Sioka E. et al. Habib EndoHPB: a novel endobiliary radiofrequency ablation device. An experimental study. J Invest Surg 2013; 26: 6-10
    CrossrefPubMedSuche in Google Scholar
  • 20 Benson AB, Abrams TA, Ben-Josef E. et al. NCCN clinical practice guidelines in oncology: hepatobiliary cancers. J Natl Compr Canc Netw 2009; 7: 350-391
    CrossrefPubMedSuche in Google Scholar
  • 21 Yang J, Shen H, Jin H. et al. Treatment of unresectable extrahepatic cholangiocarcinoma using hematoporphyrin photodynamic therapy: a prospective study. Photodiagnosis Photodyn Ther 2016; 16: 110-118
    CrossrefPubMedSuche in Google Scholar
  • 22 Cotton PB, Garrow DA, Gallagher J. et al. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc 2009; 70: 80-88
    CrossrefPubMedSuche in Google Scholar
  • 23 Ortner ME, Caca K, Berr F. et al. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology 2003; 125: 1355-1363
    CrossrefPubMedSuche in Google Scholar
  • 24 Rustagi T, Jamidar PA. Intraductal radiofrequency ablation for management of malignant biliary obstruction. Dig Dis Sci 2014; 59: 2635-2641
    CrossrefPubMedSuche in Google Scholar
  • 25 Sharaiha RZ, Sethi A, Weaver KR. et al. Impact of radiofrequency ablation on malignant biliary strictures: results of a collaborative registry. Dig Dis Sci 2015; 60: 2164-2169
    CrossrefPubMedSuche in Google Scholar
  • 26 Figueroa-Barojas P, Bakhru MR, Habib NA. et al. Safety and efficacy of radiofrequency ablation in the management of unresectable bile duct and pancreatic cancer: a novel palliation technique. J Oncol 2013; 2013: 910897
    PubMedSuche in Google Scholar
  • 27 Alis H, Sengoz C, Gonenc M. et al. Endobiliary radiofrequency ablation for malignant biliary obstruction. Hepatobiliary Pancreat Dis Int 2013; 12: 423-427
    CrossrefPubMedSuche in Google Scholar
  • 28 Dolak W, Schreiber F, Schwaighofer H. et al. Endoscopic radiofrequency ablation for malignant biliary obstruction: a nationwide retrospective study of 84 consecutive applications. Surg Endosc 2014; 28: 854-860
    CrossrefPubMedSuche in Google Scholar
  • 29 Sharaiha RZ, Natov N, Glockenberg KS. et al. Comparison of metal stenting with radiofrequency ablation versus stenting alone for treating malignant biliary strictures: is there an added benefit?. Dig Dis Sci 2014; 59: 3099-3102
    CrossrefPubMedSuche in Google Scholar
  • 30 Kallis Y, Phillips N, Steel A. et al. Analysis of endoscopic radiofrequency ablation of biliary malignant strictures in pancreatic cancer suggests potential survival benefit. Dig Dis Sci 2015; 60: 3449-3455
    CrossrefPubMedSuche in Google Scholar
  • 31 Uppal DS, Wang AY. Advances in endoscopic retrograde cholangiopancreatography for the treatment of cholangiocarcinoma. World J Gastrointest Endosc 2015; 7: 675-687
    CrossrefPubMedSuche in Google Scholar
  • 32 Zhou C, Wei B, Gao K. et al. Biliary tract perforation following percutaneous endobiliary radiofrequency ablation: a report of two cases. Oncol Lett 2016; 11: 3813-3816
    CrossrefPubMedSuche in Google Scholar
  • 33 Itoi T, Isayama H, Sofuni A. et al. Evaluation of effects of a novel endoscopically applied radiofrequency ablation biliary catheter using an ex-vivo pig liver. J Hepatobiliary Pancreat Sci 2012; 19: 543-547
    CrossrefPubMedSuche in Google Scholar
  • 34 Luo H, Zhao L, Leung J. et al. Routine pre-procedural rectal indometacin versus selective post-procedural rectal indometacin to prevent pancreatitis in patients undergoing endoscopic retrograde cholangiopancreatography: a multicentre, single-blinded, randomised controlled trial. Lancet 2016; 387: 2293-2301
    CrossrefPubMedSuche in Google Scholar
  • 35 Wang Y, Cui W, Fan W. et al. Percutaneous intraductal radiofrequency ablation in the management of unresectable Bismuth types III and IV hilar cholangiocarcinoma. Oncotarget 2016; 7: 53911-53920
    PubMedSuche in Google Scholar