A successful treatment by hepatic arterial infusion therapy for advanced, unresectable biliary tract cancer

Abstract

Biliary tract cancers (BTC) are relatively rare tumors, and the prognosis is extremely poor. There has been no standard chemotherapy for advanced BTC. However, recently, gemcitabine (GEM) have been used against BTC as the most active agent, and promising response rates and overall survival times with tolerable drug toxicities have been observed. In this article, two cases of advanced intrahepatic cholangiocarcinoma and unresectable metastatic gallbladder (GB) cancer are reported. They were treated with hepatic arterial infusion (HAI) chemotherapy using a combination of GEM and cisplatin, along with the systemic administration of GEM. As a consequence, multiple liver tumors, the GB cancer and metastatic lymph nodes regressed without severe drug toxicities, and favorable results (the overall survival times were 16 and 14 mo, respectively) were achieved. In conclusion, HAI therapy using GEM combined with cisplatin may be a useful and well-tolerated option for advanced BTC, especially in cases where multiple liver metastases are detected.

Keywords: Cisplatin; Gallbladder cancer; Gemcitabine; Hepatic arterial infusion; Intrahepatic cholangiocarcinoma.

Figure 1

Contrast-enhanced (CE) computed tomography of the abdomen revealed a huge tumor, measuring 11 cm in diameter, which presented with ring enhancement in the arterial phase and central necrosis. A: In the medial segment; B: Multiple small-sized tumors mainly located in the anterior and medial segments of the liver.

Figure 2

Biopsied specimens from one of the hepatic tumors. A: A moderately-differentiated adenocarcinoma with wide-spread necrosis, which were not accompanied by hepatic cell components (HE × 200); B: Positive immunostaining for cytokeratin 7 (× 200) in the adenocarcinoma cells; C: Immuno-positive AFP (× 200) in the adenocarcinoma cells.

Figure 3

FDG-PET CT after the end of 2 cycles of chemotherapy revealed abnormal uptake in the hepatic tumors in both lobes and the LNs in the liver hilus and para-aorta.

Figure 4

Images after the end of 7 cycles of chemotherapy. A: CE-CT showed a reduction in the size of a huge tumor seen in the medial segment; B: PET-CT revealed abnormal uptake only in the tumors in the medial segment, and no uptake was observed in tumors from the right lobe and the LNs in the liver hilus and para-aorta.

Figure 5

Clinical course and changes in the serum levels of CA19-9 and AFP.

Figure 6

CE-CT after the end of 4 cycles of i.v. administration chemotherapy showed that the tumor increased in size. A: The GB tumor; B: Liver tumor.

Figure 7

Clinical course and changes in the serum levels of CA19-9 and CEA.

Figure 8

CE-CT after the end of 3 cycles of HAI chemotherapy showed a decrease in the size of tumor. A: The GB tumor; B: Liver tumor.