<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Background</h3>
<p>The outcome of systemic therapy (ST) for unresectable and metastatic intrahepatic cholangiocarcinoma (iCCA) is poor. This study aims to further evaluate the efficacy and safety of locoregional therapy combined with systemic therapy (LRT + ST) compared with only ST in unresectable and metastatic iCCA by performing a systematic literature review and meta-analysis.</p>
</sec>
<sec><h3>Methods</h3>
<p>A comprehensive search was performed in PubMed, Web of Science, EMBASE, and the Cochrane Library up to November 3, 2022. The primary outcome was overall survival (OS), and the secondary outcomes were progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs).</p>
</sec>
<sec><h3>Results</h3>
<p>Ten retrospective cohort studies with 3,791 unresectable or metastatic iCCA patients were enrolled in this study, including 1,120 who received ablation, arterially directed therapy (ADT), or external beam radiation therapy (EBRT) combined with ST. The meta-analysis showed that the LRT + ST group had a better OS (<italic>HR</italic> = 0.51; <italic>95% CI</italic> =0.41–0.64; <italic>p value</italic> &lt; 0.001), PFS (<italic>HR</italic> = 0.40, <italic>95% CI</italic> = 0.22–0.71, <italic>p value</italic> = 0.002) and ORR (<italic>RR</italic> = 1.68; <italic>95% CI</italic> = 1.17–2.42; <italic>p value</italic> = 0.005). Subgroup analysis showed that both ST combined with ADT (<italic>HR</italic> = 0.42, <italic>95% CI</italic> = 0.31–0.56, <italic>p value</italic> &lt; 0.001) and EBRT (<italic>HR</italic> = 0.67, <italic>95% CI</italic> = 0.63–0.72, <italic>p value</italic> &lt; 0.001) could improve OS. Neutropenia, thrombocytopenia, anemia, anorexia, and vomiting did not show significant differences between the groups (p value > 0.05).</p>
</sec>
<sec><h3>Conclusions</h3>
<p>Compared with only ST, LRT + ST improved survival outcomes for unresectable and metastatic iCCA patients without increasing severe AEs, which can further provide a basis for guidelines.</p>
</sec>
</abstract>

Background
The outcome of systemic therapy (ST) for unresectable and metastatic intrahepatic cholangiocarcinoma (iCCA) is poor. This study aims to further evaluate the efficacy and safety of locoregional therapy combined with systemic therapy (LRT + ST) compared with only ST in unresectable and metastatic iCCA by performing a systematic literature review and meta-analysis.

Methods
A comprehensive search was performed in PubMed, Web of Science, EMBASE, and the Cochrane Library up to November 3, 2022. The primary outcome was overall survival (OS), and the secondary outcomes were progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs).

Results
Ten retrospective cohort studies with 3,791 unresectable or metastatic iCCA patients were enrolled in this study, including 1,120 who received ablation, arterially directed therapy (ADT), or external beam radiation therapy (EBRT) combined with ST. The meta-analysis showed that the LRT + ST group had a better OS (HR = 0.51; 95% CI =0.41–0.64; p value < 0.001), PFS (HR = 0.40, 95% CI = 0.22–0.71, p value = 0.002) and ORR (RR = 1.68; 95% CI = 1.17–2.42; p value = 0.005). Subgroup analysis showed that both ST combined with ADT (HR = 0.42, 95% CI = 0.31–0.56, p value < 0.001) and EBRT (HR = 0.67, 95% CI = 0.63–0.72, p value < 0.001) could improve OS. Neutropenia, thrombocytopenia, anemia, anorexia, and vomiting did not show significant differences between the groups (p value > 0.05).

Conclusions
Compared with only ST, LRT + ST improved survival outcomes for unresectable and metastatic iCCA patients without increasing severe AEs, which can further provide a basis for guidelines.

Locoregional therapy combined with systemic therapy (LRT + ST) for unresectable and metastatic intrahepatic cholangiocarcinoma: a systematic review and meta-analysis

Key Laboratory of Cancer Molecular and Translational Research

The Affiliated Hospital of Qingdao University

Qingdao Municipal Center for Disease Control & Prevention

Radiology and Oncology

This work is licensed under the Creative Commons Attribution 4.0 International License.

Background
The outcome of systemic therapy (ST) for unresectable and metastatic intrahepatic cholangiocarcinoma (iCCA) is poor. This study aims to further evaluate the efficacy and safety of locoregional therapy combined with systemic therapy (LRT + ST) compared with only ST in unresectable and metastatic iCCA by performing a systematic literature review and meta-analysis.

Methods
A comprehensive search was performed in PubMed, Web of Science, EMBASE, and the Cochrane Library up to November 3, 2022. The primary outcome was overall survival (OS), and the secondary outcomes were progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs).

Results
Ten retrospective cohort studies with 3,791 unresectable or metastatic iCCA patients were enrolled in this study, including 1,120 who received ablation, arterially directed therapy (ADT), or external beam radiation therapy (EBRT) combined with ST. The meta-analysis showed that the LRT + ST group had a better OS (HR = 0.51; 95% CI =0.41–0.64; p value  0.05).

Conclusions
Compared with only ST, LRT + ST improved survival outcomes for unresectable and metastatic iCCA patients without increasing severe AEs, which can further provide a basis for guidelines.

Background
The outcome of systemic therapy (ST) for unresectable and metastatic intrahepatic cholangiocarcinoma (iCCA) is poor. This study aims to further...

Locoregional therapy combined with systemic therapy (LRT + ST) for unresectable and metastatic intrahepatic cholangiocarcinoma: a systematic review and meta-analysis

Article Category: Review

Published Online: Nov 30, 2023

Page range: 419 - 429

Received: Jun 01, 2023

Accepted: Sep 18, 2023

DOI: https://doi.org/10.2478/raon-2023-0059

Keywords
unresectable iCCA, locoregional therapy, systemic therapy, meta-analysis

© 2023 Mengqi Zhang et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Locoregional therapy combined with systemic therapy (LRT + ST) for unresectable and metastatic intrahepatic cholangiocarcinoma: a systematic review and meta-analysis

Article Category: Review

Published Online: Nov 30, 2023

Page range: 419 - 429

Received: Jun 01, 2023

Accepted: Sep 18, 2023

DOI: https://doi.org/10.2478/raon-2023-0059

Keywordsunresectable iCCA, locoregional therapy, systemic therapy, meta-analysis

© 2023 Mengqi Zhang et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Keywords
unresectable iCCA, locoregional therapy, systemic therapy, meta-analysis