Arterial Infusion Chemotherapy and Biliary Stenting for Unresectable Hilar Cholangiocarcinoma: 161

Purpose: Unresectable hilar cholangiocarcinoma are associated with a very poor prognosis. The feasibility and efficacy of arterial infusion chemotherapy of 5-fluorouracil and Gemcitabine with biliary drainage by tube and metal stent insertion were evaluated. Methods: From January 2002 to December 2004, we treated 10 patients with unresectable hilar cholangiocarcinoma. Continuous intra-arterial chemotherapy was administered using percutaneously implantable port-catheter system with the tip fixed at the gastroduodenal artery with coils and side hole opened at the common hepatic artery. 5-fluorouracil was administered at a dose of 350 mg/m2 on days 1 to 7 and 15 to 21 as a continuous arterial infusion. Gemcitabine was delivered at a dose of 700 mg/m2 once weekly for 3 consecutive weeks of every 4 weeks as a 30-min arterial infusion. Metal stent placement in the right biliary duct and tube stent in the left were performed with a bilateral transhepatic approach in all patients. Results: Overall, there were 3 grade III chemotoxic events related to treatment. Chemotoxic events included two hematologic events and one gastrointestinal event. Catheter obstruction occurred in one patient and the catheter replacement was performed. Biliary obstruction recurred in 5 patients (50%). Tumor overgrowth was the major cause of reobstruction. Reintervention was performed in 4 patients. 3 of the 4 patients benefited from repeated intervention. Mean and median survival were, respectively, 18.2 and 21 months. Conclusions: Arterial infusion chemotherapy of 5-fluorouracil and Gemcitabine with biliary drainage by metal and tube stent appears to be an effective and safe treatment option for unresectable hilar cholangiocarcinoma.