Personalised radioembolization improves outcomes in refractory intra-hepatic cholangiocarcinoma: a multicenter study

Levillain, Hugo; Derijckere, Ivan Duran; Ameye, Lieveke; Guiot, Thomas; Braat, Arthur J. A. T.; Meyer, Carsten H.; Vanderlinden, Bruno; Reynaert, N.; Hendlisz, Alain; Lam, Mandy M.; Deroose, Christophe M.; Ahmadzadehfar, Hojjat; Flamen, Patrick

doi:10.1007/s00259-019-04427-z

Cited by 57 publications

(43 citation statements)

References 28 publications

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“…However, Levillain et al showed that the efficacy of TARE in unresectable ICC significantly depends on the delivered tumor radiation dose. Mean tumoral radiation dose was higher with the partition model applied compared to the body-surface area model, suggesting that a personalized radiation activity regime should be performed for each patient [13].…”

Section: Discussionmentioning

confidence: 99%

“…Since the first reports, 90 Y radioembolization has been shown to be an effective method for both primary liver cancer, especially HCC, as well as secondary liver cancer, with the most existing evidence in metastatic colorectal cancer [8,9]. There is an increasing number of reports on the use of 90 Y radioembolization for intrahepatic cholangiocarcinoma, but the evidence of resin-based 90 Y microspheres in the treatment of unresectable and chemorefractory ICC is still limited [3,[10][11][12][13][14]. First results suggest that the median overall survival treating ICC with 90 Y radioembolization is 13.9 months (9.5-18.3 months), thus being at least as high compared to systemic chemotherapy, but potentially reduced side effects [3].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Factors for Overall Survival in Advanced Intrahepatic Cholangiocarcinoma Treated with Yttrium-90 Radioembolization

Köhler

Harders

Lohöfer

et al. 2019

JCM

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Purpose: To evaluate factors associated with survival following transarterial 90Y (yttrium) radioembolization (TARE) in patients with advanced intrahepatic cholangiocarcinoma (ICC). Methods: This retrospective multicenter study analyzed the outcome of three tertiary care cancer centers in patients with advanced ICC following resin microsphere TARE. Patients were included either after failed previous anticancer therapy, including relapse after surgical resection, or for having a minimum of 25% of total liver volume affected by ICC. Patients were stratified and response was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) criteria at 3 months. Kaplan–Meier analysis was performed to analyze survival followed by cox regression to determine independent prognostic factors for survival. Results: 46 patients were included (19 male, 27 female), median age 62.5 years (range 29–88 years). A total of 65% of patients had undergone previous therapy, while 63% had a tumor volume > 25% of the entire liver volume. Median survival was 9.5 months (95% CI: 6.1–12.9 months). Due to loss in follow-up, n = 37 patients were included in the survival analysis. Cox regression revealed the extent of liver disease to one or both liver lobes being associated with survival, irrespective of tumor volume (p = 0.041). Patients with previous surgical resection of ICC had significantly decreased survival (3.9 vs. 12.8 months, p = 0.002). No case of radiation-induced liver disease was observed. Discussion: Survival after 90Y TARE in patients with advanced ICC primarily depends on disease extent. Only limited prognostic factors are associated with a general poor overall survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic Factors for Overall Survival in Advanced Intrahepatic Cholangiocarcinoma Treated with Yttrium-90 Radioembolization

Köhler

Harders

Lohöfer

et al. 2019

JCM

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“…It's reported that ALB can predict survival in several malignancies including HCC, CC, colorectal cancer and renal cell carcinoma, etc. 30 - 32 . Moreover, serum ALB serves as a nutritional index and reflects synthetic function of liver.…”

Section: Discussionmentioning

confidence: 99%

Albumin-to-Alkaline Phosphatase Ratio is an Independent Prognostic Indicator in Combined Hepatocellular and Cholangiocarcinoma

Zhang¹,

Lu²,

Tian³

et al. 2020

J. Cancer

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Background: The clinical significance of Albumin-to-Alkaline Phosphatase Ratio (AAPR) has been discussed in hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). The aim of this study is to clarify the prognostic value of AAPR in patients with combined hepatocellular and cholangiocarcinoma (cHCC-CCA). Methods: A total of 267 patients pathologically diagnosed as Allen type C cHCC-CCA in our institution were retrospectively enrolled and randomly divided into the training (N=187) cohort and validation (N=80) cohort. The prognostic value of AAPR was evaluated and validated. An AAPR-based nomogram was constructed and its prediction performance was assessed. Results: We identified 0.43 as the optimal threshold value of AAPR by the X-tile software. In the training cohort, the median overall survival (OS) of patients with AAPR < 0.43 was significant shorter than that of those with AAPR ≥ 0.43(15.8 months vs 35 months, respectively, P < 0.001). Univariate and multivariate analyses demonstrated that AAPR was a strong indicator of OS. The concordance index (C-index), receiver operating characteristic (ROC) curves, likelihood ratio tests (LAT), Akaike information criteria (AIC) and decision curve analysis (DCA) demonstrated that AAPR outperformed the Child-Pugh (CP) grade and albumin-bilirubin (ALBI) grade in predicting OS. These findings were further verified in the validation cohort. The AAPR-based nomogram achieved C-index values of 0.76 (95%CI: 0.71-0.81) in the training cohort and 0.69 (95%CI: 0.60-0.78) in the validation cohort, which presented significant superiority to TNM stage. Conclusions: Preoperative AAPR is an independent prognostic predictor in cHCC-CCA. The AAPR-based nomogram contributes to personalized prognosis prediction and clinical decision making for cHCC-CCA.

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“…At the time of the study's conception in 2014, available studies on TARE consisted of large cohort series and smaller experimental trials [8][9][10][11][12][13][14][15][16][17]. In the meantime, several large-scale randomized controlled trials on TARE in mCRC and HCC have been completed and published [18][19][20][21][22], as well as large prospective and retrospective studies on HCC, ICC and mCRC [23][24][25][26][27][28][29][30]. As more centres in Europe included TARE in their armamentarium of treatments for liver malignancies, there was a need for a multicentre, prospective data collection on the use of TARE in clinical practice beyond high-expertise centres, where countries with different health-care systems were able to contribute to evaluate how TARE is used in standard clinical practice in Europe [31].…”

Section: Introductionmentioning

confidence: 99%

Clinical Application of Trans-Arterial Radioembolization in Hepatic Malignancies in Europe: First Results from the Prospective Multicentre Observational Study CIRSE Registry for SIR-Spheres Therapy (CIRT)

Helmberger

Golfieri

Pech

et al. 2020

Cardiovasc Intervent Radiol

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Purpose To address the lack of prospective data on the real-life clinical application of trans-arterial radioembolization (TARE) in Europe, the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) initiated the prospective observational study CIRSE Registry for SIR-Spheres® Therapy (CIRT). Materials and Methods Patients were enrolled from 1 January 2015 till 31 December 2017. Eligible patients were adult patients treated with TARE with Y90 resin microspheres for primary or metastatic liver tumours. Patients were followed up for 24 months after treatment, whereas data on the clinical context of TARE, overall survival (OS) and safety were collected. Results Totally, 1027 patients were analysed. 68.2% of the intention of treatment was palliative. Up to half of the patients received systemic therapy and/or locoregional treatments prior to TARE (53.1%; 38.3%). Median overall survival (OS) was reported per cohort and was 16.5 months (95% confidence interval (CI) 14.2–19.3) for hepatocellular carcinoma, 14.6 months (95% CI 10.9–17.9) for intrahepatic cholangiocarcinoma. For liver metastases, median OS for colorectal cancer was 9.8 months (95% CI 8.3–12.9), 5.6 months for pancreatic cancer (95% CI 4.1–6.6), 10.6 months (95% CI 7.3–14.4) for breast cancer, 14.6 months (95% CI 7.3–21.4) for melanoma and 33.1 months (95% CI 22.1–nr) for neuroendocrine tumours. Statistically significant prognostic factors in terms of OS include the presence of ascites, cirrhosis, extra-hepatic disease, patient performance status (Eastern Cooperative Oncology Group), number of chemotherapy lines prior to TARE and tumour burden. Thirty-day mortality rate was 1.0%. 2.5% experienced adverse events grade 3 or 4 within 30 days after TARE. Conclusion In the real-life clinical setting, TARE is largely considered to be a part of a palliative treatment strategy across indications and provides an excellent safety profile. Level of evidence Level 3. Trial registration ClinicalTrials.gov NCT02305459.

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Personalised radioembolization improves outcomes in refractory intra-hepatic cholangiocarcinoma: a multicenter study

Cited by 57 publications

References 28 publications

Prognostic Factors for Overall Survival in Advanced Intrahepatic Cholangiocarcinoma Treated with Yttrium-90 Radioembolization

Prognostic Factors for Overall Survival in Advanced Intrahepatic Cholangiocarcinoma Treated with Yttrium-90 Radioembolization

Albumin-to-Alkaline Phosphatase Ratio is an Independent Prognostic Indicator in Combined Hepatocellular and Cholangiocarcinoma

Clinical Application of Trans-Arterial Radioembolization in Hepatic Malignancies in Europe: First Results from the Prospective Multicentre Observational Study CIRSE Registry for SIR-Spheres Therapy (CIRT)

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