Liver Cancer
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2005; 11(8): 1091-1095
Published online Feb 28, 2005. doi: 10.3748/wjg.v11.i8.1091
Initial experience from a combination of systemic and regional chemotherapy in the treatment of patients with nonresectable cholangiocellular carcinoma in the liver
Timm Kirchhoff, Lars Zender, Sonja Merkesdal, Bernd Frericks, Nisar Malek, Joerg Bleck, Stefan Kubicka, Stefan Baus, Ajay Chavan, Michael P. Manns, Michael Galanski
Timm Kirchhoff, Stefan Baus, Michael Galanski, Department of Diagnostic Radiology, Hannover Medical School, Germany
Lars Zender, Nisar Malek, Joerg Bleck, Stefan Kubicka, Michael P. Manns, Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Germany
Sonja Merkesdal, Division of Rheumatology, Hannover Medical School, Germany
Bernd Frericks, Department of Radiology and Nuclear Medicine, Campus B.F-Charité-University Medicine, Berlin, Germany
Ajay Chavan, Department of Radiology and Nuclear Medicine, Klinikum Oldenburg, Germany
Author contributions: All authors contributed equally to the work.
Correspondence to: Timm Kirchhoff, M.D., Department of Diagnostic Radiology, OE 8220, Hannover Medical School, Carl-Neuberg Str.1, D-30625 Hannover, Germany. kirchhoff.timm@mh-hannover.de
Telephone: +49-511-5323421 Fax: +49-511-5328262
Received: July 31, 2004
Revised: August 2, 2004
Accepted: September 19, 2004
Published online: February 28, 2005
Abstract

AIM: In nonresectable cholangiocellular carcinoma (CCC) therapeutic options are limited. Recently, systemic chemotherapy has shown response rates of up to 30%. Additional regional therapy of the arterially hyper vascularized hepatic tumors might represent a rational approach in an attempt to further improve response and palliation. Hence, a protocol combining transarterial chemoembolization and systemic chemotherapy was applied in patients with CCC limited to the liver.

METHODS: Eight patients (6 women, 2 men, mean age 62 years) with nonresectable CCC received systemic chemotherapy (gemcitabine 1000 mg/m2) and additional transarterial chemoembolization procedures (50 mg/m2 cisplatin, 50 mg/m2 doxorubicin, up to 600 mg degradable starch microspheres). Clinical follow-up of patients, tumor markers, CT and ultrasound were performed to evaluate maximum response and toxicity.

RESULTS: Both systemic and regional therapies were tolerated well; no severe toxicity (WHO III/IV) was encountered. Nausea and fever were the most commonly observed side effects. A progressive rarefication of the intrahepatic arteries limited the maximum number of chemoembolization procedures in 4 patients. A median of 2 chemoembolization cycles (range, 1-3) and a median of 6.5 gemcitabine cycles (range, 4-11) were administered. Complete responses were not achieved. As maximum response, partial responses were achieved in 3 cases, stable diseases in 5 cases. Two patients died from progressive disease after 9 and 10 mo. Six patients are still alive. The current median survival is 12 mo (range, 9-18); the median time to tumor progression is 7 mo (range, 3-18). Seven patients suffered from tumor-related symptoms prior to therapy, 3 of these experienced a treatment-related clinical relief. In one patient the tumor became resectable under therapy and was successfully removed after 10 mo.

CONCLUSION: The present results indicate that a combination of systemic gemcitabine therapy and repeated regional chemoembolizations is well tolerated and may enhance the effect of palliation in a selected group of patients with intrahepatic nonresectable CCC.

Keywords: Cholangiocellular carcinoma; Gemcitabine; Intraarterial chemoembolization