Personalised radioembolization improves outcomes in refractory intra-hepatic cholangiocarcinoma: a multicenter study
Levillain, Hugo; Duran Derijckere, Ivan; Ameye, Lieveke; Guiot, Thomas; Braat, Arthur; Meyer, Carsten; Vanderlinden, Bruno; Reynaert, Nick; Hendlisz, Alain; Lam, Marnix; Deroose, Christophe M.; Ahmadzadehfar, Hojjat; Flamen, Patrick
(2019) European Journal of Nuclear Medicine and Molecular Imaging, volume 46, issue 11, pp. 2270 - 2279
(Article)
Abstract
PURPOSE: Reported outcomes of patients with intra-hepatic cholangiocarcinoma (IH-CCA) treated with radioembolization are highly variable, which indicates differences in included patients' characteristics and/or procedure-related variables. This study aimed to identify patient- and treatment-related variables predictive for radioembolization outcome. METHODS: This retrospective multicenter study enrolled 58 patients with unresectable and chemorefractory
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IH-CCA treated with resin 90Y-microspheres. Clinicopathologic data were collected from patient records. Metabolic parameters of liver tumor(s) and presence of lymph node metastasis were measured on baseline 18F-FDG-PET/CT. 99mTc-MAA tumor to liver uptake ratio (TLR MAA) was computed for each lesion on the SPECT-CT. Activity prescription using body-surface-area (BSA) or more personalized partition-model was recorded. The study endpoint was overall survival (OS) starting from date of radioembolization. Statistical analysis was performed by the log-rank test and multivariate Cox's proportional hazards model. RESULTS: Median OS (mOS) post-radioembolization of the entire cohort was 10.3 months. Variables associated with significant differences in terms of OS were serum albumin (hazard ratio (HR) = 2.78, 95%CI:1.29-5.98, p = 0.002), total bilirubin (HR = 2.17, 95%CI:1.14-4.12, p = 0.009), aspartate aminotransferase (HR = 2.96, 95%CI:1.50-5.84, p < 0.001), alanine aminotransferase (HR = 2.02, 95%CI:1.05-3.90, p = 0.01) and γ-GT (HR = 2.61, 95%CI:1.31-5.22, p < 0.001). The presence of lymph node metastasis as well as a TLR MAA < 1.9 were associated with shorter mOS: HR = 2.35, 95%CI:1.08-5.11, p = 0.008 and HR = 2.92, 95%CI:1.01-8.44, p = 0.009, respectively. Finally, mOS was significantly shorter in patients treated according to the BSA method compared to the partition-model: mOS of 5.5 vs 14.9 months (HR = 2.52, 95%CI:1.23-5.16, p < 0.001). Multivariate analysis indicated that the only variable that increased outcome prediction above the clinical variables was the activity prescription method with HR of 2.26 (95%CI:1.09-4.70, p = 0.03). The average mean radiation dose to tumors was significantly higher with the partition-model (86Gy) versus BSA (38Gy). CONCLUSION: Radioembolization efficacy in patients with unresectable recurrent and/or chemorefractory IH-CCA strongly depends on the tumor radiation dose. Personalized activity prescription should be performed.
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Keywords: Intra-hepatic cholangiocarcinoma, Radioembolization, Resin microspheres, SIRT, Yttrium-90, Radiology Nuclear Medicine and imaging, Journal Article
ISSN: 1619-7070
Publisher: Springer Verlag
Note: Funding Information: This work was not supported by a grant. Acknowledgments Funding Information: This academic work was supported and sponsored by the Jules Bordet Institute. Part of the results was presented at the 2019 SNMMI–annual congress of the Society of Nuclear Medicine and Molecular Imaging as an oral presentation during the GI – Colorectal, liver, esophageal session (OP- 216). Publisher Copyright: © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
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