Intra-arterial Yttrium-90 Radioembolization Combined with Systemic Chemotherapy is a Promising Method for Downstaging Unresectable Huge Intrahepatic Cholangiocarcinoma to Surgical Treatment View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2015-01-27

AUTHORS

M. Rayar, L. Sulpice, J. Edeline, E. Garin, G. B. Levi Sandri, B. Meunier, E. Boucher, K. Boudjema

ABSTRACT

PurposeTo evaluate the downstaging efficacy of yttrium-90 radioembolization (Ytt-90)-associated with chemotherapy and the results of surgery for initially unresectable huge intrahepatic cholangiocarcinoma (ICC).MethodsBetween January 2008 and October 2013, unresectable ICC were treated with chemotherapy and Ytt-90. Patients with unique tumors localized to noncirrhotic livers and without extrahepatic metastasis were considered to be potentially resectable and were evaluated every 2 months for possible secondary resection.ResultsForty-five patients were treated for unresectable ICCs; ten had potentially resectable tumors, and eight underwent surgery. Initial unresectability was due to the involvement of the hepatic veins or portal vein of the future liver remnant in seven and one cases, respectively. Preoperative treatment induced significant decreases in tumor volume (295 vs. 168 ml, p = 0.02) and allowed for R0 resection in all cases. Three patients (37.5 %) had Clavien–Dindo grade three or higher complications, including two postoperative deaths. The median follow-ups were 15.6 [range 4–40.7] months after medical treatment initiation and 7.2 [0.13–36.4] months after surgery. At the end of the study period, five patients were still alive, with one patient still alive 40 months after medical treatment initiation (36.4 months after surgery); two patients experienced recurrences.ConclusionsFor initially unresectable huge ICCs, chemotherapy with Ytt-90 radioembolization is an effective downstaging method that allows for secondary resectability. More... »

PAGES

3102-3108

References to SciGraph publications

  • 2012-09-07. Yttrium-90 Radioembolization for Unresectable Standard-chemorefractory Intrahepatic Cholangiocarcinoma: Survival, Efficacy, and Safety Study in CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
  • 2013-03-15. Volumetric Changes after 90Y Radioembolization for Hepatocellular Carcinoma in Cirrhosis: An Option to Portal Vein Embolization in a Preoperative Setting? in ANNALS OF SURGICAL ONCOLOGY
  • 2013-07-25. Clinical impact of FDG PET-CT on management decisions for patients with primary biliary tumours in INSIGHTS INTO IMAGING
  • 2009-10-30. Yttrium-90 Radiotherapy for Unresectable Intrahepatic Cholangiocarcinoma: A Preliminary Assessment of This Novel Treatment Option in ANNALS OF SURGICAL ONCOLOGY
  • 2013-07-12. Intra-arterial Therapy for Advanced Intrahepatic Cholangiocarcinoma: A Multi-institutional Analysis in ANNALS OF SURGICAL ONCOLOGY
  • 2008-11-07. Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis in EUROPEAN RADIOLOGY
  • 2007-11-07. Surgical Management of Intrahepatic Cholangiocarcinoma - A Population-Based Study in ANNALS OF SURGICAL ONCOLOGY
  • 2007-09-05. Trends in Survival after Surgery for Cholangiocarcinoma: A 30-Year Population-Based SEER Database Analysis in JOURNAL OF GASTROINTESTINAL SURGERY
  • 2014-09-05. Liver Resection for Metastatic Disease After Y90 Radioembolization: A Case Series with Long-Term Follow-Up in ANNALS OF SURGICAL ONCOLOGY
  • 2011-03-24. Transarterial Hepatic Yttrium-90 Radioembolization in Patients with Unresectable Intrahepatic Cholangiocarcinoma: Factors Associated with Prolonged Survival in CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1245/s10434-014-4365-3

    DOI

    http://dx.doi.org/10.1245/s10434-014-4365-3

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1046997006

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/25623598


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    38 schema:description PurposeTo evaluate the downstaging efficacy of yttrium-90 radioembolization (Ytt-90)-associated with chemotherapy and the results of surgery for initially unresectable huge intrahepatic cholangiocarcinoma (ICC).MethodsBetween January 2008 and October 2013, unresectable ICC were treated with chemotherapy and Ytt-90. Patients with unique tumors localized to noncirrhotic livers and without extrahepatic metastasis were considered to be potentially resectable and were evaluated every 2 months for possible secondary resection.ResultsForty-five patients were treated for unresectable ICCs; ten had potentially resectable tumors, and eight underwent surgery. Initial unresectability was due to the involvement of the hepatic veins or portal vein of the future liver remnant in seven and one cases, respectively. Preoperative treatment induced significant decreases in tumor volume (295 vs. 168 ml, p = 0.02) and allowed for R0 resection in all cases. Three patients (37.5 %) had Clavien–Dindo grade three or higher complications, including two postoperative deaths. The median follow-ups were 15.6 [range 4–40.7] months after medical treatment initiation and 7.2 [0.13–36.4] months after surgery. At the end of the study period, five patients were still alive, with one patient still alive 40 months after medical treatment initiation (36.4 months after surgery); two patients experienced recurrences.ConclusionsFor initially unresectable huge ICCs, chemotherapy with Ytt-90 radioembolization is an effective downstaging method that allows for secondary resectability.
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