2416. Chemosaturation With Percutaneous Hepatic Perfusion (PHP) as a Treatment Option in Unresectable Cholangiocarcinoma: A New Perspective?
Authors * Denotes Presenting Author
  1. Cornelia Dewald *; Hannover Medical School
  2. Lena Becker; Hannover Medical School
  3. Sabine Maschke; Hannover Medical School
  4. Anna Saborowksi; Hannover Medical School
  5. Frank Wacker; Hannover Medical School
  6. Arndt Vogel; Hannover Medical School
  7. Jan Hinrichs; Hannover Medical School
Cholangiocarcinomas (CCAs) are the second most common primary liver tumors and carry a poor prognosis. Chemosaturation with percutaneous hepatic perfusion (PHP) is a palliative, intraarterial therapeutic approach that provides high-dose chemotherapy to the liver with reduced systemic exposure. The aim of this retrospective, monocentric study was to analyze PHP as a palliative treatment for unresectable CCA.

Materials and Methods:
Toxicity and complications were classified using the Common Terminology Criteria for Adverse Events (CTCAE v5.0). Overall response rate (ORR) and disease control rate (DCR) were assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST1.1). Median overall survival (mOS), median progression-free survival (mPFS), and hepatic mPFS (mhPFS) were evaluated using the Kaplan-Meier estimator.

In total, 17 patients were treated with 42 PHP procedures between October 2014 and September 2020. No significant complications occurred during the procedures. Overall, mOS was 10 (interquartile range months (IQR) 4-21) following the first PHP. ORR was 25% and DCR 75%. The mPFS was 4 months (IQR 2-7) and mhPFS was 4 months (IQR 3-10). Significant, but transient hematotoxic and hepatotoxic adverse events after PHP were frequent. CTCAE grade 3 and 4 thrombopenia were recorded after 50%, leukopenia after 26% and anemia after 21% of the PHP procedures. An increase of liver transaminases (AST increase after 21% and ALT increase after 14% of the procedures) as well as deterioration of liver synthesis (hyperbilirubinemia after 5% and hypoalbuminemia after 14% of the PHP) were less common.

Salvage treatment with PHP is effective in selected patients with unresectable CCA. The interventional procedure is safe. Postinterventional toxicity is frequent but manageable.