Effect of transarterial radioembolization therapy on survival in intrahepatic cholangiocellular carcinoma

Yıl 2019, Cilt: 44 Sayı: 4, 1379 - 1385, 29.12.2019

Hüseyin Tuğsan Ballı İsa Burak Güney Ferhat Can Pişkin Kairgeldy Aikimbaev

https://doi.org/10.17826/cumj.598480

Öz

Purpose: The aim of this study was to present the survival analyses of patients with intrahepatic cholangiocellular carcinoma who are ineligible forsurgical treatment and treated with transarterial radioembolization.

Materials and Methods: Twenty-eight patients with intrahepatic cholangiocellular carcinoma who were not eligible for surgical treatment were included in this study. All patients were treated by transarterial radioembolization. The survival time of the patients who were followed up after diagnosis was recorded. Kaplan-Meier survival analysis was used to calculate survival.

Results: The mean age was 60.46 years. While minimum age of patients was 36 years, maximum age of patients 84 years. The median follow-up was 14 months (min:3, max:33). The median survival time of the patients was 22 months (min:3 months, max:33 months). In addition, the survival time of patients who received chemotherapy and patients who did not receive chemotherapy, patients with solitary tumor, patients with multifocal tumor, patients with tumor unilobar and patients with bilobar were calculated and no significant difference was found between the groups.

Conclusion: Although modern chemotherapy has increased this survival rate, it has not been able to increase the median survival beyond 12 months. When these data are taken into consideration, it is seen that transarterial radioembolization treatment prolongs survival.

Anahtar Kelimeler

Liver, cholangiocellular carcinoma

İntrahepatik kolanjiyosellüler karsinomlarda transarteriyel radyoembolizasyon tedavisinin sağkalım üzerine etkisi

Öz

Amaç: Bu çalışmanın amacı, cerrahi tedaviye uygun olmayan ve transarteriyel radyoembolizasyon yöntemi ile tedavi edilen intrahepatik kolanjiyosellüler karsinom hastalarının sağkalım sonuçlarını sunmaktır.

Gereç ve Yöntem: Bu çalışmaya intrahepatik kolanjiyosellüler karsinom tanısı almış ve cerrahi tedaviye uygun olmayan 28 hasta dahil edildi. Hastaların tamamı transarteriyel radyoembolizasyon yöntemi ile tedavi edildi. Tanı konduktan sonra takipleri başlayan hastaların sağkalım süreleri kayıt altına alındı. Sağkalım süreleri hesaplanırken Kaplan-Meier yaşam analizi kullanıldı.

Bulgular: Çalışmada toplamda 28 hasta değerlendirilmiştir. Ortalama yaş 60,46 yıl olup minimum yaş 36 yıl, maksimum yaş ise 84 yıldır. Hastaların medyan takip süresi 14 ay olarak hesaplandı (min:3– maks:33). Hastaların medyan sağkalım süresi 22 (min:3 ay, max:33 ay) aydır. Ayrıca kemoterapi almış hastalar ile almamış hastalar, soliter tümörü olan hastalar ile multifokal tümörü olan hastalar, tümörü unilobar olan hastalar ile bilobar olan hastaların sağkalım süreleri hesaplandı ve gruplar arasında anlamlı bir farklılık bulunmadı.

Sonuç: Modern kemoterapi uygulamaları bu sağkalım oranında artış sağlamış olsa da medyan sağkalımı 12 ayın üzerine çıkaramamıştır. Bu veriler dikkate alındığında transarteriyel radyoembolizasyon tedavisinin sağkalım süresini uzattığı görülmektedir.

Anahtar Kelimeler

kolanjiyosellüler karsinom, radyoembolizasyon

Kaynakça

• KAYNAKLAR
• 1. Rafi S, Piduru SM, El-Rayes B, et al. Yttrium-90 radioembolization for unresectable standard-chemorefractory intrahepatic cholangiocarcinoma: survival, efficacy, and safety study. Cardiovasc Intervent Radiol 2013;36:440-8.
• 2.Shaib Y, El-Serag HB. The epidemiology of cholangiocarcinoma. Semin. Liver Dis. 2004;24:115–25.
• 3. Park J, Kim M-H, Kim K-P, Park DH, Moon S-H, Song TJ, et al. Natural Historyand Prognostic Factors of Advanced Cholangiocarcinoma without Surgery, Chemotherapy, or Radiotherapy: A Large-Scale Observational Study. Gut Liver. 2009;3:298–305.
• 4.Seidensticker R, Ricke J, Seidensticker M. Integration of chemoembolization and radioembolization into multimodal treatment of cholangiocarcinoma. Best Practice&Research Clinical Gastroenterology 29 (2015) 319-332.
• 5. Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD. Cholangiocarcinoma. LancetLond. Engl. 2005;366:1303–14.
• 6. Rizvi S, Khan SA, Hallemeier CL, Kelley RK, Gores GJ. Cholangiocarcinoma – evolving concepts and therapeutic strategies. Nat. Rev. Clin. Oncol. 2017.7. Akinwande O, Shah V, Mills A, Noda C, Weiner E, et al. Chemoembolization versusradioembolization for the treatment of unresectable intrahepatic cholangiocarcinoma in a single institution image-based efficacy and comparative toxicity. Hepat. Oncol. 2017; 4(3), 75–81.
• 8. Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N. Engl. J. Med. 2010;362:1273–81.
• 9. Bourien H, Palard X, Rolland Y, Le Du F, Beuzit L,et al. Yttrium-90 glass microspheres radioembolization (RE) for biliary tract cancer: a large single-center experience. Eur J Nucl Med Mol Imaging.2018;1-8.
• 10. Nezami N, Kokabi N, CamachoJC, Schuster DM, Xing M, et al. Y90 radioembolization dosimetry using a simple semi-quantitative method in intrahepatic cholangiocarcinoma: Glass versus resin microspheres. Nuclear Medicine and Biology 59 2018: 22–28.
• 11. Fidelman N, Kerlan RK, Hawkins RA. 90Y Glass Microspheres for the Treatment of Unresectable Metastatic Liver Disease from Chemotherapy-Refractory Gastrointestinal Cancers: A Pilot Study. J GastrointestCanc 2014 45:168–180.
• 12. Zechlinski JJ, Rilling WS. Transarterial Therapies for the Treatment of Intrahepatic Cholangiocarcinoma Semin Intervent Radiol 2013;30:21–27.13. Hoffmann RT, Paprottka PM, Schön A, et al. Transarterial hepatic yttrium-90 radioembolization in patients with unresectable intrahepatic cholangiocarcinoma: factors associated with prolonged survival. Cardiovasc Intervent Radiol 2012;35:105-16.
• 14. Jakobs TF, Hoffmann RT, Fischer T et al. Radioembolization in patients with hepatic metastases from breast cancer.J Vasc Interv Radiol 2008: 19(5):683–690.15. Peterson JL, Vallow LA, Johnson DW, Heckman MG, Diehl NN, Smith AA, et al. Complications after 90Y microsphere radioembolization for unresectable hepatic tumors: An evaluation of 112 patients. Brachytherapy. 2013;12:573–9.
• 16. Ibrahim SM, Mulcahy MF, Lewandowski RJ. Treatment of unresectable cholangiocarcinoma using yttrium-90 microspheres: results from a pilot study. Cancer 2008,113: 2119–2128.
• 17. Gangi A, Shah J, Hatfield N. Intrahepatic Cholangiocarcinoma Treated with Transarterial Yttrium-90 Glass Microsphere Radioembolization: Results of a Single Institution Retrospective Study. J Vasc Interv Radiol 2018:1–8.
• 18. Saxena A, Bester L, Chua TC, et al. Yttrium-90 radiotherapy for unresectable intrahepatic cholangiocarcinoma: a preliminary assessment of this novel treatment option. Ann Surg Oncol 2010;17:484-91.
• 19. Soydal Ç, Kucuk NO, Bilgic S, Ibis E. Radioembolization with 90Y resin microspheres for intrahepatic cholangiocellular carcinoma: prognostic factors. Ann Nucl Med 2016 30:29–34
• 20. Al-Adra DP, Gill RS, Axford SJ, et al. Treatment of unresectable intrahepatic cholangiocarcinoma with yttrium-90 radioembolization: a systematic review and pooled analysis. Eur J SurgOncol 2015;41:120-7.
• 21. Hickey R, Mulcahy MF, Lewandowski RJ, et al. Chemoradiation of hepatic malignancies: prospective, phase 1 study of full-dose capecitabine with escalating doses of yttrium-90 radioembolization. Int J Radiat Oncol Biol Phys 2014;88:1025-31.
• 22. https://www.esmo.org/Guidelines/Gastrointestinal-Cancers/Biliary-Cancer. Erişim Tarihi: 25.04.2019
• 23. Mahnken AH. Current status of transarterial radioembolization. World J Radiol2016 May 28; 8(5): 449-459
• 24. Gil-Alzugaray B, Chopitea A, Inarrairaegui M, et al. Prognostic factors and prevention of radioembolization-induced liver disease. Hepatology2013 Mar;57(3):1078–87.