Vincent Manceau1, Xavier Palard1,2, Yan Rolland3,4,5, March Pracht6, Samuel Le Sourd6, Sophie Laffont1, Karim Boudjema7, Astride Lievre8, Habiba Mesbah9, Laure-Anne Haumont9, Laurence Lenoir1, Vanessa Brun10, Thomas Uguen7, Julien Edeline2,6,11, Etienne Garin12,13,14. 1. Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, CS 44229, F-35042, Rennes cedex, France. 2. Université de Rennes 1, F-35033, Rennes, France. 3. Department of Medical Imaging, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerqu, CS 44229e, F-35042, Rennes cedex, France. 4. U 1099, INSERM, Rennes, France. 5. LTSI, Université de Rennes 1, Rennes, France. 6. Department of Medical Oncology, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, CS 44229, F-35042, Rennes cedex, France. 7. Department of Hepatobiliary Surgery, CHU Pontchaillou, 2 rue Henri le Guilloux, F-35033, Rennes cedex, France. 8. Department of Hepatology, CHU Pontchaillou, F-35033, Rennes cedex, France. 9. Department of Medical Information, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, CS 44229, F-35042, Rennes cedex, France. 10. Department of Medical Imaging, CHU Pontchaillou, F-35033, Rennes cedex, France. 11. INSERM, INRA, Université de Rennes 1, Université de Bretagne Loire, Nutrition Metabolisms and Cancer (NuMeCan), Rennes, France. 12. Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, CS 44229, F-35042, Rennes cedex, France. e.garin@rennes.unicancer.fr. 13. Université de Rennes 1, F-35033, Rennes, France. e.garin@rennes.unicancer.fr. 14. INSERM, INRA, Université de Rennes 1, Université de Bretagne Loire, Nutrition Metabolisms and Cancer (NuMeCan), Rennes, France. e.garin@rennes.unicancer.fr.
Abstract
PURPOSE: Selective internal radiation therapy (SIRT) appears to be an interesting treatment possibility for locally-advanced intrahepatic cholangiocarcinoma (ICC), yet the appropriate dosimetry has never been evaluated in this context. METHODS: We retrospectively studied data from 40 patients treated at our institution with 90Y-loaded glass microsphere SIRT combined with chemotherapy for inoperable ICC as first-line treatment. Macroaggregated albumin (MAA)-based single-photon emission computed tomography (SPECT)/computed tomography (CT) quantitative analysis was used to calculate the tumor dose (TD), healthy-injected liver dose (HILD), and injected liver dose (ILD). Response was evaluated at 3 months using the European Association for the Study of the Liver criteria. Factors associated with response and toxicity were analyzed using univariate analysis. RESULTS: We assessed a total of 35 patients (five excluded) receiving 55 injections. Mean TD was 322 ± 165Gy and mean HILD was 74 ± 24Gy for a mean ILD of 128 ± 28Gy. All but two lesions responded, with a minimal TD for responding lesions of 158Gy. Six Grade 3-4 permanent liver toxicities were observed. Mean HILD was not associated with liver toxicity (73.2 ± 25.8Gy for patients with liver toxicity and 77.8 ± 16.9Gy for patients without, ns). Only underlying Child-Pugh status (p = 0.0014) and underlying cirrhosis (p = 0.0021) were associated with liver toxicity. Median progression-free survival was 12.7 months and median overall survival (OS) was 28.6 months. Median OS was 52.7 months for patients with Child-Pugh A5 status. CONCLUSIONS: When combined with chemotherapy, SIRT is highly effective, with a TD > 158Gy. Tolerance was good except for the few patients with cirrhosis or Child-Pugh status ≥A6, who exhibited some liver toxicity. Prospective studies are warranted to confirm.
PURPOSE: Selective internal radiation therapy (SIRT) appears to be an interesting treatment possibility for locally-advanced intrahepatic cholangiocarcinoma (ICC), yet the appropriate dosimetry has never been evaluated in this context. METHODS: We retrospectively studied data from 40 patients treated at our institution with 90Y-loaded glass microsphere SIRT combined with chemotherapy for inoperable ICC as first-line treatment. Macroaggregated albumin (MAA)-based single-photon emission computed tomography (SPECT)/computed tomography (CT) quantitative analysis was used to calculate the tumor dose (TD), healthy-injected liver dose (HILD), and injected liver dose (ILD). Response was evaluated at 3 months using the European Association for the Study of the Liver criteria. Factors associated with response and toxicity were analyzed using univariate analysis. RESULTS: We assessed a total of 35 patients (five excluded) receiving 55 injections. Mean TD was 322 ± 165Gy and mean HILD was 74 ± 24Gy for a mean ILD of 128 ± 28Gy. All but two lesions responded, with a minimal TD for responding lesions of 158Gy. Six Grade 3-4 permanent liver toxicities were observed. Mean HILD was not associated with liver toxicity (73.2 ± 25.8Gy for patients with liver toxicity and 77.8 ± 16.9Gy for patients without, ns). Only underlying Child-Pugh status (p = 0.0014) and underlying cirrhosis (p = 0.0021) were associated with liver toxicity. Median progression-free survival was 12.7 months and median overall survival (OS) was 28.6 months. Median OS was 52.7 months for patients with Child-Pugh A5 status. CONCLUSIONS: When combined with chemotherapy, SIRT is highly effective, with a TD > 158Gy. Tolerance was good except for the few patients with cirrhosis or Child-Pugh status ≥A6, who exhibited some liver toxicity. Prospective studies are warranted to confirm.
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