4:24 PM, Abstract No. 292 - Radioembolization for unresectable intrahepatic cholangiocarcinoma: single center review of imaging response and survival

Abstract

Purpose: Intrahepatic cholangiocarcinoma (ICC) is often locally advanced at diagnosis, precluding surgical resection. While several chemotherapy and locoregional approaches have been investigated for treatment of unresectable ICC, there exists no widely accepted standard. We report our experience with selective internal radioembolization therapy (SIRT) with yttrium-90 for locally advanced ICC. Materials and Methods: Patients with unresectable ICC who were selected for SIRT were retrospectively reviewed. Patient demographics, performance, and survival data were acquired from patient medical records and the Social Security Death Index. Tumor response and time to progression (TTP) were assessed on CT/MRI using RECIST criteria. Statistical analysis was performed using Kaplan-Meier survival estimator and log-rank tests. Major and minor adverse events (AEs) were assessed up to 30 days. Results: From 6/2008 to 7/2014, 26 patients (mean age 67 12 y) that had previously received chemotherapy (n1⁄413), resection (n1⁄46) or no treatment (n1⁄49) for ICC were selected for SIRT. Tumor lobe included left (n1⁄45), right (n1⁄47) and bilobar (n1⁄414), with average max tumor dimension 6.8 4.4 cm. Disease burden included intrahepatic-only (n1⁄413) and extrahepatic (n1⁄412). All treatments were administered successfully (mean dose 1.58 0.85 GBq) using SIR-Spheres (n1⁄418; Sirtex, N. Sydney, Australia) or Theraspheres (n1⁄48; BTG, London, UK). Seven patients were lost to follow up. Objective response rate was 21% (CR:3, PR:1; SD:7, PD:8). Disease control rate was 58%. Median TTP was 113 (94-169) days. Median TTP in patients with baseline ECOG 0 (n1⁄49) and ECOG Z 1 (n1⁄410) was 169 and 113 days, respectively (p 1⁄4 0.045, log-rank). Median survival from SIRT was 225 (95% CI 153-609) days. Post-treatment survival was significantly prolonged in patients with objective response via RECIST (p1⁄40.021, log-rank). AEs included stroke within 30 days (n1⁄41). Conclusion: SIRT for ICC is feasible and represents a treatment option for unresectable disease. Time to progression is significantly longer in ECOG 0 patients. Post-treatment survival is significantly prolonged in patients with objective response via RECIST.