SIR 2024
Interventional Oncology
Muhamad Serhal, MD
Postdoctoral Research Fellow
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Aakash Gupta, M.D.
Interventional Radiology Resident, PGY-2
Stanford University
Disclosure information not submitted.
Andrew C. Gordon, MD, PhD (he/him/his)
Integrated Interventional Radiology Resident
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Aparna Kalyan, MD
Disclosure information not submitted.
Laura Kulik, MD
Professor
Department of Medicine, Division of Hepatology, Northwestern University
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Kent Sato, MD
Professor of Radiology
Northwestern Memorial Hospital
Disclosure information not submitted.
Ahsun Riaz, MD
Associate Professor, Interventional Radiology
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Elias Hohlastos, MD
Professor
Northwestern University Feinberg School of Medicine
Disclosure information not submitted.
Riad Salem, MD, FSIR, MBA
Professor
Northwestern Memorial Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Robert Lewandowski, MD, FSIR
Professor
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
There is increasing interest in the application of radiation segmentectomy (RS) with Yttrium-90 microspheres for treating liver cancers other than Hepatocellular Carcinoma. In this study, we aim to evaluate the efficacy of RS for the treatment of early-stage intrahepatic cholangiocarcinoma (ICC).
Materials and Methods: With IRB approval, a retrospective chart review including all patients with T1a (solitary tumor ≤5 cm without vascular invasion) and T1b (solitary tumor >5cm without vascular invasion) stage ICC according to The American Joint Committee on Cancer (AJCC) staging manual 8th edition, treated with RS (up to 2 Couinaud segments, > 190 Gray (Gy) based on MIRD dosimetry) from December 2007 to September 2019. Patient demographics, treatment details, time to local tumor progression (TTP), and overall survival (OS) were analyzed. Kaplan-Meier statistics were used to assess time to progression (TTP) and overall survival (OS) from date of RS and censored at last follow-up or date of resection.
Results:
15 patients with biopsy-confirmed disease met inclusion criteria (median age 65.5 years; 60% male); 11 (73%) were classified as T1a and 4 (27%) as T1b. 13 patients were treatment naïve, while two received chemotherapy before RS. The median perfused volume was 201.4 cc (range 44.3-438.8), and received a median tumor absorbed dose of 308.2 Gy (range 194.2-879.3 Gy). Based on WHO criteria, best tumor response was complete response in 2 (13.3%), partial response in 7 (46.7%), and stable disease in 6 (40.0%) patients. The median censored target lesion TTP was 43.4 months (95% CI 26.0 to no estimate), and the median censored non-target liver TTP was not reached. The median censored OS was 71.8 months (95% CI 37.8-105.8), and 3 patients were resected (range 2.4-5.0 months after RS) for curative treatment, with pathology revealing complete pathologic necrosis.
Conclusion:
This study shows promising potential for RS in treating early-stage ICC. Prospective trials with larger sample sizes are required to confirm these findings and compare RS with other treatments for early-stage ICC.