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

Autor: Levillain H; Nuclear Medicine Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium. hugo.levillain@bordet.be., Duran Derijckere I; Nuclear Medicine Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium., Ameye L; Data Center Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium., Guiot T; Medical Physics Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium., Braat A; Radiology and Nuclear Medicine Department, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands., Meyer C; Radiology Department, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany., Vanderlinden B; Medical Physics Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium., Reynaert N; Medical Physics Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium., Hendlisz A; Digestive Oncology Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium., Lam M; Radiology and Nuclear Medicine Department, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands., Deroose CM; Department of Imaging and Pathology, Nuclear Medicine, University Hospitals Leuven and Nuclear Medicine and Molecular Imaging, KU Leuven, Herestraat 49, 3000, Leuven, Belgium., Ahmadzadehfar H; Nuclear Medicine Department, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany., Flamen P; Nuclear Medicine Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium.
Jazyk: angličtina
Zdroj: European journal of nuclear medicine and molecular imaging [Eur J Nucl Med Mol Imaging] 2019 Oct; Vol. 46 (11), pp. 2270-2279. Date of Electronic Publication: 2019 Jul 19.
DOI: 10.1007/s00259-019-04427-z
Abstrakt: 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 IH-CCA treated with resin 90 Y-microspheres. Clinicopathologic data were collected from patient records. Metabolic parameters of liver tumor(s) and presence of lymph node metastasis were measured on baseline 18 F-FDG-PET/CT. 99m Tc-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.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje