Schaarschmidt Benedikt M, Kloeckner Roman, Dertnig Thomas, Demircioglu Aydin, Müller Lukas, Auer Timo Alexander, Santos Daniel Pinto Dos, Steinle Verena, Miederer Matthias, Gebauer Bernhard, Radunz Sonia, Kasper Stefan, Weber Manuel, Theysohn Jens
Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany;
Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
J Nucl Med. 2023 Apr;64(4):529-535. doi: 10.2967/jnumed.122.264598. Epub 2022 Nov 3.
Limited treatment options in patients with intrahepatic cholangiocarcinoma (iCCA) demand the introduction of new, catheter-based treatment options. Especially, Y radioembolization may expand therapeutic abilities beyond surgery or chemotherapy. Therefore, the purpose of this study was to identify factors associated with an improved median overall survival (mOS) in iCCA patients receiving radioembolization in a retrospective study at 5 major tertiary-care centers. In total, 138 radioembolizations in 128 patients with iCCA (female, 47.7%; male, 52.3%; mean age ± SD, 61.1 ± 13.4 y) were analyzed. Clinical data, imaging characteristics, and radioembolization reports, as well as data from RECIST, version 1.1, analysis performed 3, 6, and 12 mo after radioembolization, were collected. mOS was compared among different subgroups using Kaplan-Meier curves and the log-rank test. Radioembolization was performed as first-line treatment in 25.4%, as second-line treatment in 38.4%, and as salvage treatment in 36.2%. In patients receiving first-line, second-line, and salvage radioembolization, the disease control rate was 68.6%, 52.8%, and 54.0% after 3 mo; 31.4%, 15.1%, and 12.0% after 6 mo; and 17.1%, 5.7%, and 6.0% after 1 y, respectively. In patients receiving radioembolization as first-line, second-line, and salvage treatment, mOS was 12.0 mo (95% CI, 7.6-23.4 mo), 11.8 mo (95% CI, 9.1-16.6 mo), and 8.4 mo (95% CI, 6.3-12.7 mo), respectively. No significant differences among the 3 groups were observed ( = 0.15). Hepatic tumor burden did not significantly influence mOS ( = 0.12). Especially in advanced iCCA, second-line and salvage radioembolization may be important treatment options. In addition to ongoing studies investigating the role of radioembolization as first-line treatment, the role of radioembolization in the later treatment stages of the disease demands further attention.
肝内胆管癌（iCCA）患者的治疗选择有限，因此需要引入新的基于导管的治疗方法。特别是，钇90放射性栓塞可能会扩大治疗能力，超越手术或化疗。因此，本研究的目的是在5家主要三级医疗中心进行的一项回顾性研究中，确定接受放射性栓塞的iCCA患者中与中位总生存期（mOS）改善相关的因素。共分析了128例iCCA患者（女性占47.7%；男性占52.3%；平均年龄±标准差为61.1±13.4岁）的138次放射性栓塞。收集了临床数据、影像特征、放射性栓塞报告，以及放射性栓塞后3、6和12个月进行的RECIST 1.1版分析的数据。使用Kaplan-Meier曲线和对数秩检验比较不同亚组的mOS。放射性栓塞作为一线治疗的占25.4%，作为二线治疗的占38.4%，作为挽救治疗的占36.2%。在接受一线、二线和挽救性放射性栓塞的患者中，3个月后的疾病控制率分别为68.6%、52.8%和54.0%；6个月后分别为31.4%、15.1%和12.0%；1年后分别为17.1%、5.7%和6.0%。在接受放射性栓塞作为一线、二线和挽救治疗的患者中，mOS分别为12.0个月（95%CI，7.6-23.4个月）、11.8个月（95%CI，9.1-16.6个月）和8.4个月（95%CI，6.3-12.7个月）。3组之间未观察到显著差异（P=0.15）。肝肿瘤负荷对mOS无显著影响（P=0.12）。特别是在晚期iCCA中，二线和挽救性放射性栓塞可能是重要的治疗选择。除了正在进行的研究放射性栓塞作为一线治疗的作用外，放射性栓塞在疾病后期治疗阶段的作用需要进一步关注。
