Twenty Years of Radiation Therapy of Unresectable Intrahepatic Cholangiocarinoma: Internal or External? A Systematic Review and Meta-Analysis

Yu, Qian; Liu, Chenyu; Pillai, Anjana; Ahmed, Osman

doi:10.1159/000516880

Cited by 11 publications

(4 citation statements)

References 81 publications

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“…On the basis of the present study, the pooled TRR and TCR were 36%–49% and 73%–97%, respectively. These findings are similar to previously reported 22%–81% and 78%–96% in the primary liver cancer such as cholangiocarcinoma ( 48 ). Radiological response is a well-known predictor of survival after SIRT of HCC and colorectal liver metastasis ( 49 , 50 ).…”

Section: Discussionsupporting

confidence: 92%

“…(46,47). While the comparative studies between EBRT and SIRT were lacking in the setting of breast cancer metastasis to the liver, a previous study on cholangiocarcinoma showed a seemingly longer survival of SIRT over EBRT as the first-line therapy (MST of 36 vs. 11 months) (48), highlighting SIRT's effectiveness in reducing hepatic tumor burden as a novel therapy compared with the more traditional EBRT approach. On the basis of the present study, the pooled TRR and TCR were 36%-49% and 73%-97%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Selective internal radiation therapy of metastatic breast cancer to the liver: A meta-analysis

et al. 2022

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IntroductionThe aim of this study is to conduct a meta-analysis to assess the efficacy of yttrium-90 selective internal radiation therapy (SIRT) in treating patients with breast cancer with hepatic metastasis.MethodPubMed and The Cochrane Library were queried from establishment to January 2021. The following keywords were implemented: “breast”, “yttrium”, and “radioembolization”. The following variables and outcomes were collected: publication year, region, sample size, study design, presence of extrahepatic disease, tumor burden, infused radioactivity, breast cancer subtype, previous treatment, median survival time (MST), length of follow-up, adverse events, and radiographical response such as Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST).ResultsA total of 24 studies from 14 institutions were included in the present meta-analysis. On the basis of the data from 412 patients, post-embolization MST was 9.8 [95% confidence interval (CI): 9.0–11.6] months. Patients with additional extrahepatic metastasis had a poorer survival rate compared with those with localized hepatic metastasis only (MST: 5.3 vs. 15 months, p < 0.0001). Patients with <25% liver tumor burden exhibited more promising survival than those with >25% (MST: 10.5 vs. 6.8 months, p < 0.0139). On the basis of RECIST, mRECIST, and PERCIST criteria, tumor response rate was 36% (95% CI: 26%–47%), 49% (95% CI: 34%–65%), and 47% (95% CI: 17%–78%), respectively, whereas tumor control rate was 85% (95% CI: 76%–93%), 73% (95% CI: 59%–85%), and 97% (95% CI: 91%–100%), respectively.ConclusionOn the basis of the available published evidence, SIRT is feasible and effective in treating patients with breast cancer with liver metastasis. Patients with lower hepatic tumor burden and without extrahepatic metastasis demonstrated more survival benefit. Future randomized controlled trials are warranted.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Selective internal radiation therapy of metastatic breast cancer to the liver: A meta-analysis

et al. 2022

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“…The median survival time was 13.6 months and 12 months for EBRT and SIRT, respectively. When comparing treatments, it was found that current studies are too heterogeneous for there to be definitive conclusions [19]. Similar findings were found by Edeline et al, who completed a pooled analysis of various locoregional therapies, including EBRT and SIRT.…”

Section: Unresectable or Inoperable Ccasupporting

confidence: 78%

The Current Role of Radiation in the Management of Cholangiocarcinoma—A Narrative Review

Verma,

Grindrod,

Breadner

et al. 2024

Cancers

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Cholangiocarcinoma (CCA) is a rare cancer of bile ducts. It is associated with a poor prognosis. The incidence of CCA is rising worldwide. Anatomical subgroups have been used to classify patients for treatment and prognosis. There is a growing understanding of clinically important distinctions based on underlying genetic differences that lead to different treatment options and outcomes. Its management is further complicated by a heterogeneous population and relative rarity, which limits the conduct of large trials to guide management. Surgery has been the primary method of therapy for localized disease; however, recurrence and death remain high with or without surgery. Therefore, there have been concerted efforts to investigate new treatment options, such as the use of neoadjuvant treatments to optimize surgical outcomes, targeted therapy, leveraging a new understanding of immunobiology and stereotactic radiation. In this narrative review, we address the evidence to improve suboptimal outcomes in unresectable CCA with radiation, as well as the role of radiation in neoadjuvant and postoperative treatment. We also briefly discuss the recent developments in systemic treatment with targeted therapies and immune checkpoint inhibitors.

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“…In addition to these studies examining radiotherapy, several studies on trans-arterial chemoembolization (TACE), hepatic arterial infusion (HAI), TARE, and radiofrequency ablation (RFA) have shown mixed findings in the treatment of unresectable intrahepatic ICC and remain active areas of investigation [3]. Retrospective comparisons between RT and other modalities have been inconclusive given the wide heterogeneity of patients treated across modalities [25].…”

Section: Hypofractionated Rt For Iccmentioning

confidence: 99%

Benchmarking Outcomes after Ablative Radiotherapy for Molecularly Characterized Intrahepatic Cholangiocarcinoma

Abu‐Gheida

Patel

et al. 2021

JPM

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We have previously shown that ablative radiotherapy (A-RT) with a biologically effective dose (BED10) ≥ 80.5 Gy for patients with unresectable intrahepatic cholangiocarcinoma (ICC) is associated with longer survival. Despite recent large-scale sequencing efforts in ICC, outcomes following RT based on genetic alterations have not been described. We reviewed records of 156 consecutive patients treated with A-RT for unresectable ICC from 2008 to 2020. For 114 patients (73%), next-generation sequencing provided molecular profiles. The overall survival (OS), local control (LC), and distant metastasis-free survival (DMFS) were estimated using the Kaplan–Meier method. Univariate and multivariable Cox analyses were used to determine the associations with the outcomes. The median tumor size was 7.3 (range: 2.2–18.2) cm. The portal vein thrombus (PVT) was present in 10%. The RT median BED10 was 98 Gy (range: 81–144 Gy). The median (95% confidence interval) follow-up was 58 (42–104) months from diagnosis and 39 (33–74) months from RT. The median OS was 32 (29–35) months after diagnosis and 20 (16–24) months after RT. The one-year OS, LC, and intrahepatic DMFS were 73% (65–80%), 81% (73–87%), and 34% (26–42%). The most common mutations were in IDH1 (25%), TP53 (22%), ARID1A (19%), and FGFR2 (13%). Upon multivariable analysis, the factors associated with death included worse performance status, larger tumor, metastatic disease, higher CA 19-9, PVT, satellitosis, and IDH1 and PIK3CA mutations. TP53 mutation was associated with local failure. Further investigation into the prognostic value of individual mutations and combinations thereof is warranted.

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Twenty Years of Radiation Therapy of Unresectable Intrahepatic Cholangiocarinoma: Internal or External? A Systematic Review and Meta-Analysis

Cited by 11 publications

References 81 publications

Selective internal radiation therapy of metastatic breast cancer to the liver: A meta-analysis

Selective internal radiation therapy of metastatic breast cancer to the liver: A meta-analysis

The Current Role of Radiation in the Management of Cholangiocarcinoma—A Narrative Review

Benchmarking Outcomes after Ablative Radiotherapy for Molecularly Characterized Intrahepatic Cholangiocarcinoma

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