Interventional Radiology Locoregional Therapies for Intrahepatic Cholangiocarcinoma

Abstract

Surgical resection remains the cornerstone of curative treatment for intrahepatic cholangiocarcinoma (iCCA), but this option is only available to a small percentage of patients. For patients with unresectable iCCA, systemic therapy with gemcitabine and platinum-based agents represents the mainstay of treatment; however, the armamentarium has grown to include targeted molecular therapies (e.g., FGFR2 inhibitors), use of adjuvant therapy, liver transplantation in select cases, immunotherapy, and locoregional liver-directed therapies. Despite advances, iCCA remains a challenge due to the advanced stage of many patients at diagnosis. Furthermore, given the improving options for systemic therapy and the fact that the majority of iCCA patients succumb to disease progression in the liver, the role of locoregional therapies has increased. This review will focus on the expanding role of interventional radiology and liver-directed therapies in the treatment of iCCA.

Keywords: SIRT; TACE; Y90; cryoablation; interventional radiology; intrahepatic cholangiocarcinoma; irreversible electroporation; locoregional treatment; microwave ablation; radiofrequency ablation.

Figure 1

77-year-old male with a 3.7 cm intrahepatic cholangiocarcinoma (iCCA) in Segment 4A of the liver who underwent percutaneous cryoablation. (a) Selected arterial-phase contrast-enhanced T1-weighted magnetic resonance imaging (MRI) image demonstrating avid enhancement of the iCCA (arrow) compared to background liver parenchyma. (b) Selected delayed-phase contrast-enhanced T1-weighted MRI image demonstrating persistently elevated enhancement of the iCCA (arrow) relative to background liver. (c) Selected pre-procedural non-contrast axial CT image demonstrating the iCCA (arrow) as hypodense relative to background liver parenchyma. (d) Selected intra-procedural non-contrast axial CT image demonstrating two of a total of three cryoablation probes positioned within the iCCA, as well as associated “ice ball” (arrow). (e) Selected 1-month post-cryoablation arterial-phase contrast-enhanced T1-weighted MRI image demonstrating absence of previously seen tumoral enhancement. (f) Selected 1-month post-cryoablation delayed-phase contrast-enhanced T1-weighted MRI image demonstrating absence of previously seen tumoral enhancement.