Systematic review and pooled analysis of locoregional therapies in patients with intrahepatic cholangiocarcinoma

Abstract

Background:Locoregional treatments (LRT) including radioembolisation (SIRT),transarterial chemo-embolisation (TACE), hepatic arterial infusion (HAI) of chemo-therapy, external beam radiotherapy (EBRT) and ablation, have been studied for themanagement of intrahepatic cholangiocarcinoma (iCC). The aim of this systematicreview was to provide outcome benchmarks for clinical trial design.Methods:Identification of studies reporting outcomes of patients treated with LRTfor iCC was performed using PubMed and Embase. Pooled weighted means werecalculated for progression-free survival (PFS) and overall survival (OS); meta-analysisof proportions was used for estimation of pooled response rate.Results:6325 entries were reviewed; 93 studies were eligible, representing 101 co-horts and a total of 3990 patients [15 cohorts (645 patients) for ablation, 18 cohorts(541 patients) for EBRT, 27 cohorts (1232 patients) for SIRT, 22 cohorts (1145 patients)for TACE, 16 cohorts (331 patients) for HAI and 3 cohorts (96 patients) not pooled].74% of the studies were retrospective, 93% non-randomised; and 19% were onlyavailable in abstract form. The pooled mean weighted OS was 30.2 months (95%confidence interval (CI): 21.8-38.6) for ablation, 18.9 (14.2-23.5) for EBRT, 14.1 (12.1-16.0) for SIRT, 15.9 (12.9-19.0) for TACE and 21.3 (15.4-27.1) for HAI. The pooledcomplete response rate was 93.9% for ablation. When analysed together, SIRT, TACEand HAI had a pooled mean weighted OS of 15.7 months (all patients) and 25.2months for patients treated infirst-line with concomitant systemic chemotherapy.Conclusions:Available literature on LRT for iCC was heterogeneous and of insufficientquality to make strong recommendations. Ablation achieved satisfactory outcomes,and may be recommended when surgery is not feasible. Benchmark outcome esti-mates are provided to inform the design of phase III trials.