Background: Patients with irresectable perihilar cholangiocarcinoma (PHC) have a limited prognosis with median survival times still less than 1 year. In addition to the current standard first-line systemic chemotherapy (gemcitabine and a platinum derivate), endoscopic treatment aims to ensure adequate drainage of the biliary system by placing biliary plastic or metal stents. Local ablative procedures like intraluminal biliary brachytherapy (ILBT) or photodynamic therapy (PDT) are used to improve local tumor control and to optimize the stent patency. Summary: Intraductal radiofrequency ablation (RFA) is another promising tool in the therapeutic armamentarium for the endoscopic management and tumor ablation of extrahepatic cholangiocarcinoma (eCCA). By applying thermal energy to the tissue through high-frequency alternating current, RFA induces coagulative necrosis and causes local destruction of the tumor. It is established as a first line percutaneous treatment of solid liver tumors, and since 2011 an endoscopic catheter is available that allows intraductal RFA in the biliary or pancreatic ducts. While the first pilot studies primarily evaluated this new method in patients with distal eCCA, there is now evidence accumulating also for PHC. Two retrospective and two prospective studies demonstrated a significantly improved overall survival and a longer stent patency with intraductal RFA, which overall had a favorable safety profile and was not associated with a significant increase in adverse events. However, prospective studies comparing the efficacy and safety of intraductal RFA, PDT, and/or ILBT are lacking. Key Messages: Recent studies suggest that intraductal RFA is an effective and well-tolerated additional treatment option with regard to stent patency but also overall survival. Since RFA has fewer systemic side effects and requires less logistical effort when compared to ILBT and PDT, intraductal RFA should be considered as another safe and feasible adjuvant method for the palliative care of patients with advanced PHC. Since comparative studies are lacking, the choice of the local ablative method remains in each case an individual decision.
Visc Med

中文翻译：

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导管内 RFA 的作用：肺门周围胆管癌姑息治疗的新工具

背景：不可切除的肺门周围胆管癌 (PHC) 患者预后有限，中位生存时间仍不到 1 年。除了目前标准的一线全身化疗（吉西他滨和铂衍生物）外，内镜治疗旨在通过放置胆道塑料或金属支架确保胆道系统充分引流。像管腔内胆道近距离放射治疗 (ILBT) 或光动力治疗 (PDT) 等局部消融手术用于改善局部肿瘤控制并优化支架通畅性。概括：导管内射频消融 (RFA) 是肝外胆管癌 (eCCA) 的内窥镜管理和肿瘤消融治疗设备中的另一种有前途的工具。RFA通过高频交流电向组织施加热能，诱导凝固性坏死并导致肿瘤局部破坏。它被确立为实体肝肿瘤的一线经皮治疗，自 2011 年以来，可使用内窥镜导管，允许在胆管或胰管中进行导管内 RFA。虽然第一个试点研究主要在远端 eCCA 患者中评估了这种新方法，但现在也有关于 PHC 的证据。两项回顾性和两项前瞻性研究表明，导管内 RFA 显着提高了总生存期和更长的支架通畅率，总体上具有良好的安全性，并且与不良事件的显着增加无关。然而，缺乏比较导管内 RFA、PDT 和/或 ILBT 的有效性和安全性的前瞻性研究。关键信息：最近的研究表明，导管内 RFA 是一种有效且耐受性良好的附加治疗选择，可提高支架通畅率和总生存率。由于与 ILBT 和 PDT 相比，RFA 具有较少的全身副作用并且需要较少的后勤工作，因此导管内 RFA 应被视为晚期 PHC 患者姑息治疗的另一种安全可行的辅助方法。由于缺乏比较研究，局部烧蚀方法的选择在每种情况下仍然是个人决定。
粘性医学