Regional Chemotherapy for Biliary Tract Tumors and Hepatocellular Carcinoma

Abstract

Locally advanced hepatocellular carcinoma and intrahepatic cholangiocarcinoma are associated with a grim prognosis. The development of highly effective systemic therapies for these tumors has been challenging; however, numerous locoregional treatment alternatives have emerged, including transarterial hepatic embolization (TAE), transarterial chemoembolization (TACE), drug-eluting bead TACE (DEB-TACE), hepatic arterial infusion chemotherapy (HAI), radioembolization, and stereotactic body radiation therapy. Although there is potential for long-term disease control for these therapies, the evidence to guide adequate patient selection and choose among different treatment alternatives is still limited. This review focuses on the rationale and data supporting TAE, TACE, DEB-TACE, and HAI in hepatobiliary cancers.

Keywords: Chemoembolization; Cholangiocarcinoma; Hepatic arterial infusion chemotherapy; Hepatocellular carcinoma.

Figure 1.

Placement of the hepatic arterial infusion pump catheter into the gastroduodenal artery. From Qadan M, D’Angelica MI, Kemeny NE, Cercek A, Kingham TP. Robotic hepatic arterial infusion pump placement. HPB (Oxford). 2017;19(5):429-435 with permission.

Figure 2.

Serial CT scan imaging of an unresectable ICC patient showing 76% decrease in sum of diameters of target lesions after 8 months of treatment with HAI FUDR and systemic gemcitabine and oxaliplatin (GemOx).