Image-guided ablation of recurrent or unresectable intrahepatic cholangiocarcinoma.

PURPOSE: To assess outcomes following image-guided ablation of recurrent or unresectable intrahepatic cholangiocarcinoma (ICC).

MATERIALS AND METHODS: In this retrospective study, 25 patients (14 female, ages 36-84) underwent 37 image-guided liver tumor ablation procedures to treat 47 ICC tumors (May 2004-January 2022). At initial diagnosis, 20 patients had Stage 1 or 2 and five had Stage 3 or 4 disease. Prior to ablation, 19 of 25 (76.0%) patients had progressed through prior treatments including resection (n=11), chemotherapy (n=11), transarterial embolization (n=3), or radiation (n=1); six of 25 (24.0%) were treatment naïve. Ablation modality selection was based on patient/tumor characteristics and operator preference. Primary outcomes included local progression-free survival (LPFS) and overall survival (OS) post-ablation. Statistical analysis included Kaplan-Meier (KM) survival analyses and Cox proportional hazards models.

RESULTS: Mean ablated tumor size was 2.0 ± 1.2 cm (range 0.5-5.0 cm). One, 2, and 5-year KM LPFS were 84.0% (95% CI, 72.9-96.8), 73.0% (59.0-90.4), and 59.5% (41.6-85.1). One, 2, and 5-year secondary LPFS were 89.5% (80.2-99.9), 81.9% (69.4-96.6), and 75.6% (60.2-94.9). One, 2, and 5-year KM LPFS for tumors ≤ 2cm were all 95.8% (88.2-100.0). One, 2, and 5-year procedure-OS were 78.5% (63.5-97.2), 68.4% (51.3-91.1), and 43.5% (23.5-80.5). One, 2, and 5-year diagnosis-OS were 96.0% (88.6-100.0), 78.7% (63.7-97.2), and 53.3% (33.1-85.9). Larger tumor size was associated with decreased time to local progression (hazard ratio 1.93, p=0.012).

CONCLUSIONS: Percutaneous ablation provided favorable intermediate to long-term disease control for patients with recurrent or inoperable cholangiocarcinoma.