Selective internal radiation therapy using Yttrium-90 microspheres for treatment of localized and locally advanced intrahepatic cholangiocarcinoma

Monday, March 6, 2023

3:27 PM – 3:36 PM

Location: Phoenix Convention Center, 224AB

Presenting Author(s)

QY

Qian Yu, MD (he/him/his)

Resident
University of Chicago

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

AP

Anjana Pillai, MD

Professor
University of Chicago
AL

Andy Liao, MD

Professor
The University of Chicago Medicine
TB

Talia Baker, MD

Professor
University of Chicago
JF

John Fung, MD PhD

Professor
University of Chicago
DD

Diego DiSabato, MD

Professor
University of Chicago
TV

Thuong Van Ha, MD

Professor
University of Chicago
EU

Ethan Ungchusri, MD

Resident
University of Chicago
GH

Gloria Hwang, MD

Resident
University of Chicago
Osman Ahmed, MD

Associate Prof
University of Chicago

Disclosure(s):

Qian Yu, MD: No financial relationships to disclose

Osman Ahmed, MD: Argon Medical: Advisory Committee or Review Panel Member (Ongoing); Asahi: Consultant (Ongoing); Bard Peripheral Vascular: Speaking and Teaching (Terminated, September 1, 2022); Boston Scientific: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing); Canon Medical Systems: Consultant (Ongoing), Contracted Research (Ongoing); Cook: Speaking and Teaching (Ongoing); Johnson & Johnson: Advisory Committee or Review Panel Member (Ongoing); Penumbra Inc.: Speaking and Teaching (Ongoing); Philips: Contracted Research (Terminated, October 1, 2022)

Purpose: _{To evaluate safety and effectiveness of selective internal radiation therapy (SIRT) using Yttrium-90 for localized intrahepatic cholangiocarcinoma (iCCA).}

Materials and Methods:

A retrospective review was performed of patients with localized iCCA treated with SIRT at a single institution. Overall survival (OS), local tumor response, progression-free survival (PFS), and toxicity were collected. Stratified analysis was performed based on surgical resection. Predictor analysis of OS was performed using the Fine-Grey regression analysis model with patients bridged to surgery regarded as competing events.

Results:

A total of 28 consecutive patients with localized iCCA were treated with a total of 38 sessions of SIRT (17 segmental, 13 lobar, and 8 combined deliveries) and a mean dominant target dose per session of 238.4 ± 130.0 Gy. The cumulative radiologic response rate was 16/28 (57.1%) with a median PFS of 265 days. MST was 686 days for the entire cohort with one-year and three-year survival of 78.1 % and 44.9%, respectively. Ten patients (34.5%) were downstaged to surgical intervention (7 resection, 3 transplant) and showed longer OS (p=0.025). The 1-year and 3-year OS for patients who received surgery were 100% and 62.5% (95% CI: 14.2-89.3%), respectively. Age (p=0.004), best radiologic response (p=0.001), and neutrophil/lymphocyte ratio (p=0.003) are independent predictors of OS on multivariate analysis. Two above grade 2 hyperbilirubinemia and one pleuro-biliary fistula occurred post-SIRT.

Conclusion:

SIRT for localized iCCA is safe and effective in achieving radiological response, downstage to surgery and transplant, and result in pathologic necrosis.