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Review
. 2017 Jun;34(2):92-100.
doi: 10.1055/s-0037-1602591. Epub 2017 Jun 1.

Decision Making: Intra-arterial Therapies for Cholangiocarcinoma-TACE and TARE

Brian M Currie  1 , Michael C Soulen  1
Affiliations
Review

Decision Making: Intra-arterial Therapies for Cholangiocarcinoma-TACE and TARE

Brian M Currie et al. Semin Intervent Radiol. 2017 Jun.

Abstract

The incidence of intrahepatic cholangiocarcinoma (ICC) has been increasing in recent years and now represents the second most common primary hepatic cancer in the United States. The prognosis is dismal without surgical resection. In patients ineligible to receive curative treatments, locoregional therapies represent a diverse array of techniques that can stabilize or reverse tumor progression to improve overall survival and reduce tumor-related symptoms. Transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) have been demonstrated to be efficacious methods for this patient population. Deciding between these two options is challenging. This article reviews the differences in patient selection, preprocedural evaluation, financial considerations and availability, quality of life, and rates of complications and overall survival.

Keywords: interventional radiology; intrahepatic cholangiocarcinoma; locoregional therapy; transarterial chemoembolization; transarterial radioembolization.

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Figures

Fig. 1
Fig. 1
Long-term control of intrahepatic cholangiocarcinoma (ICC) with serial ablation. ( a ) Initial presentation with 3-cm ICC, treated with radiofrequency ablation in 2010. ( b ) Marginal recurrence in 2013 treated with microwave ablation. ( c ) Superior marginal recurrence (thin arrow) above ablation cavity with “ghost” of original lesion (thick arrow). ( d ) Re-treatment with microwave ablation. ( e ) Latest imaging in 2016 shows avascular ablation cavity and no new lesions.
Fig. 2
Fig. 2
Chemoembolization of intrahepatic cholangiocarcinoma (ICC). ( a ) CT 1 month after transarterial chemoembolization shows dense lipiodol retention in a 7.7-cm ICC. ( b ) MRI at 30-month follow-up shows no residual enhancement and a 50% reduction in tumor diameter.
Fig. 3
Fig. 3
Dosimetry images for external beam radiotherapy and transarterial radioembolization (TARE). The two sets of images were reviewed at matched levels to determine if radioembolization would be safe. ( a ) Dosimetry plot for prior hilar radiation field. ( b ) Image from TARE simulation using intra-arterial Tc-99m macro-aggregated albumin for a caudate lobe recurrence.
See this image and copyright information in PMC

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