Qian Yu, MD (he/him/his)
University of Chicago
Disclosure(s): No financial relationships to disclose
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.
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.
SIRT for localized iCCA is safe and effective in achieving radiological response, downstage to surgery and transplant, and result in pathologic necrosis.