Efficacy and safety of irreversible electroporation in unresectable perihilar cholangiocarcinoma: a systematic review and meta-analysis

Author:

Scrofani Anna Rita1ORCID,Valvano Marco23ORCID,Lancellotta Valentina1,Pezzulla Donato4ORCID,Vinci Antonio56,Cornacchione Patrizia1,Bonome Paolo4,Tagliaferri Luca1ORCID,Iezzi Roberto17

Affiliation:

1. Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Roma 00168, Italy

2. Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L’Aquila , L’Aquila 67100, Italy

3. Division of Gastroenterology, Galliera Hospital , Genoa 16128, Italy

4. Radiation Oncology Unit, Responsible Research Hospital , Campobasso 86100, Italy

5. Hospital Health Management Area, Local Health Authority “Roma 1” , Roma 00193, Italy

6. Doctoral school in nursing sciences and Public Health, University of Rome “Tor Vergata” , Roma 00133, Italy

7. Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore , Roma 00168, Italy

Abstract

Abstract Objectives The prognosis of patients with perihilar-cholangiocarcinoma (PHC) is poor, with the majority presenting with unresectable disease at diagnosis. Palliative chemotherapy (CHT) is the standard treatment for unresectable PHC. Irreversible electroporation (IRE) has been introduced as a novel ablation technique, working predominantly nonthermal. This review aims to analyse the efficacy and safety of IRE in treating unresectable PHC. Methods This systematic review and meta-analysis was performed according to a specific protocol designed a priori, and reported according to the PRISMA. PubMed/MEDLINE, Scopus, and Cochrane CENTRAL were searched up to December 2023. Primary Outcome of interest of our meta-analysis was the mean Overall Survival (OS). Secondary outcomes were progression-free survival (PFS) and adverse event rate (AE). Results The mean OS was estimated at 25.49 months (CI, 21.47-38.72, I2 81.37%), PFS 17.86 (CI, 13.00-22.72, I2 11.42%), with an AE incidence of 12% (CI, 7%-31%, I2 83.57%). High heterogeneity was found among studies, with no single study fully responsible for it, suggesting high variability among facilities/populations. Conclusion IRE is effective and relatively safe for unresectable PHC. However, the lack of prospective studies and randomized trials comparing chemotherapy or locoregional treatment with IRE prevents drawing sufficiently robust conclusions. Advances in knowledge IRE appears a safe and effective technique for treating unresectable perihilar cholangiocarcinoma.

Publisher

Oxford University Press (OUP)

Reference45 articles.

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3. Risk factors and classifications of hilar cholangiocarcinoma;Suarez-Munoz;World J Gastrointest Oncol,2013

4. Long-term survival in hilar cholangiocarcinoma also possible in unresectable patients;Ruys;World J Surg,2012

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