Role of Percutaneous Ablation in the Management of Intrahepatic Cholangiocarcinoma

Abstract

Cholangiocarcinoma (CCA) is an invasive cancer accounting for <1% of all cancers and 10-15% of primary liver cancers. Intrahepatic CCA (iCCA) is associated with poor survival rates and high post-surgical recurrence rates whilst most diagnosed patients are not surgical candidates. There is a growing literature suggesting percutaneous ablative techniques for the management of patients with iCCA measuring ≤3 cm with contraindications to surgery as well as for recurrent or residual tumors aiming to provide local cancer treatment and control. Most used ablative therapies for iCCA include radiofrequency and microwave ablation with irreversible electroporation, cryoablation and reversible electroporation (electrochemotherapy) being less commonly encountered techniques. Due to the infiltrative margins of the lesion, there is a need for larger safety margins and ablation zone; multi-apparatus ablation or other variations of the technique such as balloon-assisted approaches can be utilized aiming to increase size of the zone of necrosis. The present review paper focuses upon the current role of percutaneous ablative techniques for the therapeutic management of iCCA. The purpose of this review is to present the current minimally invasive ablative techniques in the treatment of iCCA, including local control and survival rates.

Keywords: ablation; cancer; intrahepatic cholangiocarcinoma.

Figure 1

(A). A 64 y-o female patient with a post-surgical recurrent solitary mass of intrahepatic cholangiocarcinoma. CT axial scan with no IV injection of contrast medium at the beginning of ablation session illustrating the hypodense iCCA mass (white circle). (B). Coronal CT reconstruction illustrating two microwave antennas (black arrows) placed in the mass. (C). MRI 12 months post ablation (TI-weighted sequence with fat signal suppression post IV injection of Gadolinium illustrates the zone of necrosis (white arrows).

Figure 2

(A) A 59 y-o male patient with a post-surgical recurrent solitary mass of intrahepatic cholangiocarcinoma. Coronal CT reconstruction during ablation illustrates 6 IRE needles (black arrows) placed at the mass. (B) CT axial scan post IV injection of contrast medium (arterial phase) illustrates the zone of necrosis (white arrows) 3 months post ablation with no signs of remnant or recurrent tumor.