Gupta Aakash N, Serhal Muhamad, Gordon Andrew C, Gabr Ahmed, Kalyan Aparna, Kulik Laura, Sato Kent T, Riaz Ahsun, Hohlastos Elias S, Salem Riad, Lewandowski Robert J
Section of Vascular and Interventional Radiology, Department of Radiology, Stanford University, Stanford, California.
Section of Vascular and Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois.
J Vasc Interv Radiol. 2025 Apr;36(4):650-659. doi: 10.1016/j.jvir.2024.12.016. Epub 2024 Dec 19.
To validate the safety and effectiveness of radiation segmentectomy (RS) and modified radiation lobectomy (mRL) in intrahepatic cholangiocarcinoma (iCCA) and to evaluate long-term outcomes in patients with unresectable, early-stage iCCA.
A single-institution, retrospective study of patients with unresectable, solitary iCCA without extrahepatic disease or vascular involvement (Stage I) treated with RS and mRL was performed. Fifteen patients met inclusion criteria (median age, 65.5 years), including 11 (73%) with T1a disease and 4 (27%) with T1b disease. Outcomes included biochemical and clinical toxicities, tumor response by Response Evaluation Criteria in Solid Tumors (RECIST), time to progression, and overall survival (OS).
Median treatment dose was 308.2 Gy (range, 194.2-879.3 Gy). There were no cases of periprocedural mortality or hepatic deterioration. Grade 3+ clinical toxicities occurred in 1 patient (7%). The 3-month and best objective response rates by RECIST were 47% and 60%, respectively. Three patients went on to surgery with explant pathology revealing complete pathologic necrosis. Target lesion progression occurred in 4 patients at a median of 43.4 months. Median OS was 72 months. The 1-, 3-, and 5-year OS rates were 100%, 73.3%, and 50.3%, respectively.
RS and mRL were safe and effective in treating unresectable, early-stage iCCA. Overall progression of 47% and 5-year OS of 50% were comparable with those of surgical resection. RS and mRL may represent viable therapeutic options for patients with early-stage disease deemed surgically unresectable.
验证肝段切除术（RS）和改良肝叶切除术（mRL）治疗肝内胆管癌（iCCA）的安全性和有效性，并评估不可切除的早期iCCA患者的长期预后。
对接受RS和mRL治疗的不可切除、孤立性iCCA且无肝外疾病或血管侵犯（I期）的患者进行单中心回顾性研究。15例患者符合纳入标准（中位年龄65.5岁），其中11例（73%）为T1a期疾病，4例（27%）为T1b期疾病。观察指标包括生化和临床毒性、实体瘤疗效评价标准（RECIST）评估的肿瘤反应、疾病进展时间和总生存期（OS）。
中位治疗剂量为308.2 Gy（范围194.2 - 879.3 Gy）。无围手术期死亡或肝脏恶化病例。1例患者（7%）发生3级及以上临床毒性。RECIST评估的3个月和最佳客观缓解率分别为47%和60%。3例患者接受手术，切除标本病理显示完全病理坏死。4例患者出现靶病灶进展，中位时间为43.4个月。中位OS为72个月。1年、3年和5年OS率分别为100%、73.3%和50.3%。
RS和mRL治疗不可切除的早期iCCA安全有效。47%的总体疾病进展率和50%的5年OS率与手术切除相当。RS和mRL可能是被认为手术不可切除的早期疾病患者的可行治疗选择。
