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Treatment of Hepatopancreatobiliary Cancers: Open Question, Challenge, and Future Directions

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 10 May 2024 | Viewed by 12874

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Special Issue Editors

Dr. Francesco Giovinazzo

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Guest Editor

General Surgery and Organ Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy
Interests: carcinoma; hepatocellular; liver neoplasms; transplant oncology; neoadjuvant and adjuvant therapy; artificial intelligence; cholangiocarcinoma; colorectal and non-colorectal liver metastasis; pancreatic neoplasms
Special Issues, Collections and Topics in MDPI journals

Dr. Stijn van Laarhoven

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Department of HPB Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Interests: carcinoma; hepatocellular; liver neoplasms; transplant oncology; neoadjuvant and adjuvant therapy; artificial intelligence; cholangiocarcinoma; colorectal and non-colorectal liver metastasis; pancreatic neoplasms

Special Issue Information

Dear Colleagues,

The rates of hepatopancreaticobiliary (HPB) malignancies are rising. Surgery is the cornerstone of treatment. However, only marginal improvements in patient survival have been achieved over the past few decades. Anatomical localisation of the tumours in the vicinity of critical vascular structures, disease diffusion (e.g., peritoneal carcinomatosis, oligometastatic disease), and aggressive tumour biology are often responsible for poor outcomes. Recently, more aggressive approaches have been adopted, including extensive vascular resection, neoadjuvant treatments, and locoregional therapies. Liver transplantation (LT) is a well-recognised treatment for hepatocellular carcinoma (HCC) and is increasingly being considered in cholangiocarcinoma and colorectal liver metastases. Minimally invasive and ablative therapies are an adjunct or even replacement for resection. More recently, artificial intelligence in HPB surgery has shown promising implications in diagnosis and targeted treatment.

This Special Issue aims to focus on these extended indications and novel therapeutic approaches as they are paramount in improving the prognosis of these detrimental malignancies.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

Role of surgery in the localised and borderline resectable tumours;
Management of hepatic metastasis colorectal and non-colorectal;
Treatment of oligometastatic disease (peritoneal carcinomatosis from hepatobiliary cancer);
Complex surgery and extended resection;
Centralization and tumour board role;
Neoadjuvant vs adjuvant treatment (chemotherapy, locoregional therapy, target therapy, RFA);
Adjuvant treatment;
Transplant oncology;
Artificial intelligence in HPB Surgery.

We look forward to receiving your contributions.

Dr. Francesco Giovinazzo
Dr. Stijn van Laarhoven
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

carcinoma
hepatocellular
liver neoplasms
transplant oncology
neoadjuvant and adjuvant therapy
artificial intelligence
cholangiocarcinoma
colorectal and non-colorectal liver metastasis
pancreatic neoplasms

Published Papers (10 papers)

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Research

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16 pages, 297 KiB

Open AccessArticle

Feasibility and Short-Term Outcomes in Liver-First Approach: A Spanish Snapshot Study (the RENACI Project)

by Mario Serradilla-Martín, Celia Villodre, Laia Falgueras-Verdaguer, Natalia Zambudio-Carroll, José T. Castell-Gómez, Juan L. Blas-Laina, Vicente Borrego-Estella, Carlos Domingo-del-Pozo, Gabriel García-Plaza, Francisco J. González-Rodríguez, Eva M. Montalvá-Orón, Ángel Moya-Herraiz, Sandra Paterna-López, Miguel A. Suárez-Muñoz, Maialen Alkorta-Zuloaga, Gerardo Blanco-Fernández, Enrique Dabán-Collado, Miguel A. Gómez-Bravo, José I. Miota-de-Llamas, Fernando Rotellar, Belinda Sánchez-Pérez, Santiago Sánchez-Cabús, David Pacheco-Sánchez, Juan C. Rodríguez-Sanjuan, María A. Varona-Bosque, Lucía Carrión-Álvarez, Sofía de la Serna-Esteban, Cristina Dopazo, Elena Martín-Pérez, David Martínez-Cecilia, María J. Castro-Santiago, Dimitri Dorcaratto, Marta L. Gutiérrez-Díaz, José M. Asencio-Pascual, Fernando Burdío-Pinilla, Roberto Carracedo-Iglesias, Alfredo Escartín-Arias, Benedetto Ielpo, Gonzalo Rodríguez-Laiz, Andrés Valdivieso-López, Emilio De-Vicente-López, Vicente Alonso-Orduña and José M. Ramia Show full author list Hide full author list

Cancers 2024, 16(9), 1676; https://doi.org/10.3390/cancers16091676 - 26 Apr 2024

Viewed by 229

Abstract

(1) Background: The liver-first approach may be indicated for colorectal cancer patients with synchronous liver metastases to whom preoperative chemotherapy opens a potential window in which liver resection may be undertaken. This study aims to present the data of feasibility and short-term outcomes in the liver-first approach. (2) Methods: A prospective observational study was performed in Spanish hospitals that had a medium/high-volume of HPB surgeries from 1 June 2019 to 31 August 2020. (3) Results: In total, 40 hospitals participated, including a total of 2288 hepatectomies, 1350 for colorectal liver metastases, 150 of them (11.1%) using the liver-first approach, 63 (42.0%) in hospitals performing <50 hepatectomies/year. The proportion of patients as ASA III was significantly higher in centers performing ≥50 hepatectomies/year (difference: 18.9%; p = 0.0213). In 81.1% of the cases, the primary tumor was in the rectum or sigmoid colon. In total, 40% of the patients underwent major hepatectomies. The surgical approach was open surgery in 87 (58.0%) patients. Resection margins were R0 in 78.5% of the patients. In total, 40 (26.7%) patients had complications after the liver resection and 36 (27.3%) had complications after the primary resection. One-hundred and thirty-two (89.3%) patients completed the therapeutic regime. (4) Conclusions: There were no differences in the surgical outcomes between the centers performing <50 and ≥50 hepatectomies/year. Further analysis evaluating factors associated with clinical outcomes and determining the best candidates for this approach will be subsequently conducted. Full article

(This article belongs to the Special Issue Treatment of Hepatopancreatobiliary Cancers: Open Question, Challenge, and Future Directions)

13 pages, 653 KiB

Open AccessEditor’s ChoiceArticle

Elevated Glycated Haemoglobin (HbA1c) Is Associated with an Increased Risk of Pancreatic Ductal Adenocarcinoma: A UK Biobank Cohort Study

by Declan McDonnell, Adrian W. E. Cheang, Sam Wilding, Sarah H. Wild, Adam E. Frampton, Christopher D. Byrne and Zaed Z. Hamady

Cancers 2023, 15(16), 4078; https://doi.org/10.3390/cancers15164078 - 13 Aug 2023

Cited by 1 | Viewed by 1234

Abstract

Background: The role of dysglycaemia as a risk marker for Pancreatic Ductal Adenocarcinoma (PDAC) is uncertain. We investigated the relationship between glycated haemoglobin (HbA1c) and incident PDAC using a retrospective cohort study within the UK Biobank. Methods: A study involving 499,804 participants from the UK Biobank study was undertaken. Participants were stratified by diabetes mellitus (DM) status, and then by HbA1c values < 42 mmol/mol, 42–47 mmol/mol, or ≥48 mmol/mol. Cox proportional hazard models were used to describe the association between HbA1c category (with time-varying interactions) and incident PDAC. Results: PDAC occurred in 1157 participants during 11.6 (10.9–12.3) years follow up [(median (interquartile range)]. In subjects without known DM at baseline, 12 months after recruitment, the adjusted hazard ratios (aHR, 95% CI) for incident PDAC for HbA1c 42–47 mmol/mol compared to HbA1c < 42 mmol/mol (reference group) was 2.10 (1.31–3.37, p = 0.002); and was 8.55 (4.58–15.99, p < 0.001) for HbA1c ≥ 48 mmol/mol. The association between baseline HbA1c and incident PDAC attenuated with increasing duration of time of follow-up to PDAC diagnosis. Conclusions: Dysglycaemia detected by elevated HbA1c is associated with an increased risk of PDAC. The strength of the association between elevated HbA1c and incident PDAC is inversely proportional to the time from detecting dysglycaemia but remains significant for at least 60 months following HbA1c testing. Full article

(This article belongs to the Special Issue Treatment of Hepatopancreatobiliary Cancers: Open Question, Challenge, and Future Directions)

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13 pages, 778 KiB

Open AccessArticle

The Impact of Post-Pancreatectomy Acute Pancreatitis (PPAP) on Long-Term Outcomes after Pancreaticoduodenectomy: A Single-Center Propensity-Score-Matched Analysis According to the International Study Group of Pancreatic Surgery (ISGPS) Definition

by Giuseppe Quero, Claudio Fiorillo, Giuseppe Massimiani, Chiara Lucinato, Roberta Menghi, Fabio Longo, Vito Laterza, Carlo Alberto Schena, Davide De Sio, Fausto Rosa, Valerio Papa, Antonio Pio Tortorelli, Vincenzo Tondolo and Sergio Alfieri

Cancers 2023, 15(10), 2691; https://doi.org/10.3390/cancers15102691 - 10 May 2023

Cited by 1 | Viewed by 1044

Abstract

Post-pancreatectomy acute pancreatitis (PPAP) is a potentially life-threating complication. Although multiple authors demonstrated PPAP as a predisposing feature for a more detrimental clinical course, no evidence is currently present on its potential impact on long-term outcomes. The aim of this study is to evaluate how PPAP onset may influence overall (OS) and disease-free survival (DSF) after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). Patients who underwent PD for PDAC from 2006 to 2021 were enrolled. PPAP was defined according to the International Study Group of Pancreatic Surgery (ISGPS) definition. Propensity score matching (PSM) was performed in order to reduce potential selection biases. After PSM, 32 patients out of 231 PDs who developed PPAP (PPAP group) were matched to 32 patients who did not present PPAP (no-PPAP group). PPAP patients more frequently presented major post-operative complications (p = 0.02) and post-operative pancreatic fistula (POPF) (p = 0.003). Median follow-up was 26.2 months, with no difference between the two groups (p = 0.79). A comparable rate of local or distant metastases was noted in the two cohorts (p = 0.2). Five-year OS was comparable between the two populations (39.3% and 35.7% for the no-PPAP and PPAP populations, respectively; p = 0.53). Conversely, despite not being statistically significant, a worse 5-year DFS was evidenced in the case of PPAP (23.2%) as compared to the absence of PPAP (37.4%) (p = 0.51). With the limitations due to the small sample size, PPAP may potentially relate to worse long-term outcomes in terms of DFS. However, further studies with wider study populations are still needed in order to better clarify the prognostic role of PPAP. Full article

(This article belongs to the Special Issue Treatment of Hepatopancreatobiliary Cancers: Open Question, Challenge, and Future Directions)

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16 pages, 1220 KiB

Open AccessArticle

Prospective Observational Study of Prevalence, Assessment and Treatment of Pancreatic Exocrine Insufficiency in Patients with Inoperable Pancreatic Malignancy (PANcreatic Cancer Dietary Assessment—PanDA)

by Lindsay E. Carnie, Dinakshi Shah, Kate Vaughan, Zainul Abedin Kapacee, Lynne McCallum, Marc Abraham, Alison Backen, Mairéad G. McNamara, Richard A. Hubner, Jorge Barriuso, Loraine Gillespie, Angela Lamarca and Juan W. Valle

Cancers 2023, 15(8), 2277; https://doi.org/10.3390/cancers15082277 - 13 Apr 2023

Cited by 2 | Viewed by 1549

Abstract

Introduction: Pancreatic exocrine insufficiency (PEI) in patients with advanced pancreatic cancer (aPC) is well documented, but there is no consensus regarding optimal screening. Methods and analysis: Patients diagnosed with aPC referred for palliative therapy were prospectively recruited. A full dietetic assessment (including Mid-Upper Arm Circumference (MUAC), handgrip and stair-climb test), nutritional blood panel, faecal elastase (FE-1) and ¹³C-mixed triglyceride breath tests were performed. Primary objective: prevalence of dietitian-assessed PEI (demographic cohort (De-ch)); design (diagnostic cohort (Di-ch)) and validation (follow-up cohort (Fol-ch)) of a PEI screening tool. Logistic and Cox regressions were used for statistical analysis. Results: Between 1 July 2018 and 30 October 2020, 112 patients were recruited (50 (De-ch), 25 (Di-ch) and 37 (Fol-ch)). Prevalence of PEI (De-ch) was 64.0% (flatus (84.0%), weight loss (84.0%), abdominal discomfort (50.0%) and steatorrhea (48.0%)). The derived PEI screening panel (Di-ch) included FE-1 (normal/missing (0 points); low (1 point)) and MUAC (normal/missing (>percentile 25) (0 points); low (2 points)) and identified patients at high-risk (2–3 total points) of PEI [vs. low-medium risk (0–1 total points)]. When patients from the De-ch and Di-ch were analysed together, those classified by the screening panel as “high-risk” had shorter overall survival (multivariable Hazard Ratio (mHR) 1.86 (95% CI 1.03–3.36); p-value 0.040). The screening panel was tested in the Fol-ch; 78.4% patients classified as “high-risk”, of whom 89.6% had dietitian-confirmed PEI. The panel was feasible for use in clinical practice (64.8% patients completed all assessments), with high acceptability (87.5% would repeat it). Most patients (91.3%) recommended dietetic input for all patients with aPC. Conclusions: PEI is present in most patients with aPC; early dietetic input provides a holistic nutritional overview, including, but not limited to, PEI. This proposed screening panel may help to prioritise those at higher risk of PEI, requiring urgent dietitian input. Its prognostic role needs further validation. Full article

(This article belongs to the Special Issue Treatment of Hepatopancreatobiliary Cancers: Open Question, Challenge, and Future Directions)

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15 pages, 1986 KiB

Open AccessArticle

Mixed Acinar Neuroendocrine Carcinoma of the Pancreas: Comparative Population-Based Epidemiology of a Rare and Fatal Malignancy in The United States

by Amro M. Abdelrahman, Jun Yin, Roberto Alva-Ruiz, Jennifer A. Yonkus, Jennifer L. Leiting, Isaac T. Lynch, Alessandro Fogliati, Nellie A. Campbell, Danielle M. Carlson, Lewis R. Roberts, Gregory J. Gores, Rory L. Smoot, Rondell P. Graham, Thorvardur R. Halfdanarson and Mark J. Truty

Cancers 2023, 15(3), 840; https://doi.org/10.3390/cancers15030840 - 30 Jan 2023

Cited by 1 | Viewed by 2001

Abstract

Mixed acinar neuroendocrine carcinoma of the pancreas (MANEC-P) is an extremely rare malignancy with a poor prognosis. However, epidemiological estimates of MANEC-P remain unknown. This study aimed to estimate and compare the incidence, prevalence, and cancer-specific survival (CSS) of MANEC-P in the United States (US). Patients with MANEC-P were identified through the Surveillance, Epidemiology, and End Results (SEER) and National Program of Cancer Registries databases between 2000–2017. The primary outcomes included age-adjusted incidence rate, limited-duration prevalence, and CSS. A total of 630 patients were identified for the incidence analysis and 149 for the prevalence and CSS analyses. The MANEC-P incidence rate was 0.011 per 100,000 individuals, which was the lowest among pancreatic cancer histologic subtypes. The incidence rate was significantly higher in men and Black races and peaked at 75–79 years of age. The incidence rate was the lowest in the midwestern region (0.009) and the highest in the northeastern US (0.013). The 17-year prevalence was 0.00005%, indicating that 189 patients were alive in the United States at the beginning of 2018. The median CSS of MANEC-P was estimated to be 41 (23, 69) months. In conclusion, MANEC-P is very rare, and its incidence rate has been steady in the US over the last two decades. MANEC-P has a poor prognosis and is the 5th leading cause of pancreatic cancer-related death in the US. Full article

(This article belongs to the Special Issue Treatment of Hepatopancreatobiliary Cancers: Open Question, Challenge, and Future Directions)

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10 pages, 1430 KiB

Open AccessArticle

Comparison of Two 2.45 GHz Microwave Ablation Devices with Respect to Ablation Zone Volume in Relation to Applied Energy in Patients with Malignant Liver Tumours

by Simeon J. S. Ruiter, Jamila E. de Jong, Jan Pieter Pennings, Robbert J. de Haas and Koert P. de Jong

Cancers 2022, 14(22), 5570; https://doi.org/10.3390/cancers14225570 - 13 Nov 2022

Cited by 4 | Viewed by 1379

Abstract

Purpose: (i) to compare two 2.45 GHz MWA devices with respect to AZV in relation to the applied energy after MWA in patients with hepatocellular carcinoma (HCC) or colorectal liver metastasis (CRLM) and (ii) to identify potential confounders for this relationship. Methods: In total, 102 tumours, 65 CRLM and 37 HCC were included in this retrospective analysis. Tumours were treated with Emprint (n = 71) or Neuwave (n = 31) MWA devices. Ablation treatment setting were recorded and applied energy was calculated. AZV and tumour volumes were segmented on the contrast-enhanced CT scans obtained 1 week after treatment. The AZV to applied energy R(AZV:E) ratios were calculated for each tumour treatment and compared between both MWA devices and tumour types. Results: R(AZV:E)_EMPRINT was 0.41 and R(AZV:E)_NEUWAVE was 0.81, p < 0.001. Moderate correlation between AZV and applied energy was found for Emprint (r = 0.57, R² = 0.32, p < 0.001) and strong correlation was found for Neuwave (r = 0.78, R² = 0.61, p < 0.001). R(AZV:E)_CRLM was 0.45 and R(AZV:E)_HCC was 0.52, p = 0.270. Conclusion: This study confirms the unpredictability of AZVs based on the applied output energy for HCC and CRLM. No significant differences in R(AZV:E) were observed between CRLM and HCC. Significantly lower R(AZV:E) was found for Emprint devices compared to Neuwave; however, reflected energy due to cable and antenna design remains unclear and might contribute to these differences. Full article

(This article belongs to the Special Issue Treatment of Hepatopancreatobiliary Cancers: Open Question, Challenge, and Future Directions)

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Review

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19 pages, 1028 KiB

Open AccessReview

Therapeutic Approach to Post-Transplant Recurrence of Hepatocellular Carcinoma: Certainties and Open Issues

by Giuseppe Marrone, Maria Sandrina Leone, Marco Biolato, Antonio Liguori, Giuseppe Bianco, Gabriele Spoletini, Antonio Gasbarrini, Luca Miele and Maurizio Pompili

Cancers 2023, 15(23), 5593; https://doi.org/10.3390/cancers15235593 - 26 Nov 2023

Viewed by 1043

Abstract

Hepatocellular carcinoma (HCC) is a growing indication for liver transplantation (LT). Careful candidate selection is a prerequisite to keep post-LT recurrence rates within acceptable percentages. In the pre-LT period, various types of locoregional treatments and/or systemic therapies can be used for bridging or downstaging purposes. In this context, one of the factors limiting the possibility of treatment is the degree of functional liver impairment. In the LT subject, no widely accepted indications are available to guide treatment of disease recurrence and heterogeneity exists between transplant centers. Improved liver function post LT makes multiple therapeutic strategies theoretically feasible, but patient management is complicated by the need to adjust immunosuppressive therapy and to assess potential toxicities and drug–drug interactions. Finally, there is controversy and uncertainty about the use of recently introduced immunotherapeutic drugs, mainly due to the risk of organ rejection. In this paper, we will review the most recent available literature on the management of post-transplant HCC recurrence, discussing evidence and controversies. Full article

(This article belongs to the Special Issue Treatment of Hepatopancreatobiliary Cancers: Open Question, Challenge, and Future Directions)

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12 pages, 644 KiB

Open AccessReview

Exploring the Promise of Second-Line Chemotherapy in Biliary Tract Tumours: A Glimpse into Novel Treatment Approaches

by Paula Villalba Cuesta, Mercedes Avedillo Ruidiaz, Eva Ruiz Hispán, Raquel Fuentes Mateos and Angela Lamarca

Cancers 2023, 15(23), 5543; https://doi.org/10.3390/cancers15235543 - 23 Nov 2023

Viewed by 1107

Abstract

Biliary tract tumours, including bile duct, gallbladder, and ampulla of Vater malignancies, pose a rare but formidable oncologic challenge. Typically diagnosed at advanced stages, these tumours offer limited treatment options and dismal prognoses, with a five-year survival rate below 20%. First-line chemotherapy with gemcitabine-cisplatin has demonstrated only modest efficacy, leaving a pressing need for improved therapeutic strategies. This comprehensive review provides a detailed examination of the current landscape of second-line chemotherapy for biliary tract tumours. The pivotal ABC-06 trial established FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) as the standard second-line therapy, demonstrating improved overall survival compared to active symptom control alone. Conversely, the NIFTY trial introduced nal-IRI (nanoliposomal irinotecan) plus 5-FU/LV (5-fluorouracil and leucovorin) as an alternative option, demonstrating substantial gains in progression-free and overall survival. However, the posterior NALIRICC trial presented conflicting results, raising questions about the added benefit of nal-IRI. Challenges in delivering second-line chemotherapy include rapid patient performance deterioration post-first-line treatment and limited access to second-line therapy. Only a fraction of eligible patients receive second-line therapy, emphasising the need for more effective first-line therapies to maintain patient fitness. The role of monotherapy in the second-line setting remains uncertain, particularly in unfit patients, and the absence of biomarkers for tailored treatment underscores the need for ongoing research. While challenges persist, ongoing investigations offer hope for optimising second-line therapy for biliary tract tumours, promising improved outcomes for patients facing this disease. This review provides an overview of current facts and challenges when delivering second-line chemotherapy for advanced biliary tract tumours. Full article

(This article belongs to the Special Issue Treatment of Hepatopancreatobiliary Cancers: Open Question, Challenge, and Future Directions)

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21 pages, 1052 KiB

Open AccessReview

The Role of the Multiparametric MRI LiverMultiScan^TM in the Quantitative Assessment of the Liver and Its Predicted Clinical Applications in Patients Undergoing Major Hepatic Resection for Colorectal Liver Metastasis

by Tarak Chouari, Nabeel Merali, Francesca La Costa, Jonas Santol, Shelley Chapman, Alex Horton, Somaiah Aroori, John Connell, Timothy A. Rockall, Damian Mole, Patrick Starlinger, Fenella Welsh, Myrddin Rees and Adam E. Frampton

Cancers 2023, 15(19), 4863; https://doi.org/10.3390/cancers15194863 - 05 Oct 2023

Viewed by 1277

Abstract

Liver biopsy remains the gold standard for the histological assessment of the liver. With clear disadvantages and the rise in the incidences of liver disease, the role of neoadjuvant chemotherapy in colorectal liver metastasis (CRLM) and an explosion of surgical management options available, non-invasive serological and imaging markers of liver histopathology have never been more pertinent in order to assess liver health and stratify patients considered for surgical intervention. Liver MRI is a leading modality in the assessment of hepatic malignancy. Recent technological advancements in multiparametric MRI software such as the LiverMultiScan^TM offers an attractive non-invasive assay of anatomy and histopathology in the pre-operative setting, especially in the context of CRLM. This narrative review examines the evidence for the LiverMultiScan^TM in the assessment of hepatic fibrosis, steatosis/steatohepatitis, and potential applications for chemotherapy-associated hepatic changes. We postulate its future role and the hurdles it must surpass in order to be implemented in the pre-operative management of patients undergoing hepatic resection for colorectal liver metastasis. Such a role likely extends to other hepatic malignancies planned for resection. Full article

(This article belongs to the Special Issue Treatment of Hepatopancreatobiliary Cancers: Open Question, Challenge, and Future Directions)

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19 pages, 1034 KiB

Open AccessReview

Locoregional Therapy for Intrahepatic Cholangiocarcinoma: The Role of Intra-Arterial Therapies

by Leva Gorji, Hussein Aoun, Jeffrey Critchfield, Najeeb Al Hallak and Eliza W. Beal

Cancers 2023, 15(19), 4727; https://doi.org/10.3390/cancers15194727 - 26 Sep 2023

Viewed by 1162

Abstract

Intrahepatic cholangiocarcinoma (ICC) is a rare disease with a rising incidence. While surgical resection is the only curative option, the disease process is often identified in advanced stages, as this malignancy often remains clinically silent in early development. Only one-third of patients are eligible for resection at the time of diagnosis. For patients who cannot undergo resection, intra-arterial therapies are reasonable palliative treatment options; in rare occasions, these may be bridging therapies, as well. The premise of bland embolization and most chemoembolization intra-arterial therapies is that the arterial supply of the tumor is occluded to induce tumor necrosis, while radioembolization utilizes the arterial flow of the tumor to deliver radiation therapy. In this review, we discuss the use of transarterial embolization, transarterial chemoembolization, and selective internal radiation therapy for the treatment of ICC. Phase III randomized controlled clinical trials are difficult to tailor to this extremely rare and aggressive disease, but ultimately, further investigation should be pursued to define the patient population that will derive the greatest benefit from each modality. Full article

(This article belongs to the Special Issue Treatment of Hepatopancreatobiliary Cancers: Open Question, Challenge, and Future Directions)

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Treatment of Hepatopancreatobiliary Cancers: Open Question, Challenge, and Future Directions

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