Downstaging with Radioembolization or Chemotherapy for Initially Unresectable Intrahepatic Cholangiocarcinoma
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ORIGINAL ARTICLE – HEPATOBILIARY TUMORS
Downstaging with Radioembolization or Chemotherapy for Initially Unresectable Intrahepatic Cholangiocarcinoma Diane Riby, MD1, Alessandro D. Mazzotta, MD2, Damien Bergeat, MD2, Lucas Verdure, MD2, Laurent Sulpice, MD, PhD2, Heloise Bourien, MD1, Astrid Lie`vre, MD, PhD3, Yan Rolland, MD4, Etienne Garin, MD, PhD5, Karim Boudjema, MD, PhD2, and Julien Edeline, MD, PhD1 Departement of Medical Oncology, Centre Euge`ne Marquis, Rennes, France; 2Departement of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes, Rennes, France; 3Departement of Hepatogastroenterology, CHU Rennes, University of Rennes, Rennes, France; 4Departement of Interventional Radiology, Centre Euge`ne Marquis, Rennes, France; 5Departement of Nuclear Medicine, Centre Euge`ne Marquis, Rennes, France 1
ABSTRACT Objective. The aim of this retrospective study was to compare the outcomes of patients resected for intrahepatic cholangiocarcinoma (ICC) with upfront surgery or after downstaging treatment. Methods. All consecutive patients with ICC between January 1997 and November 2017 were included in a single-center database and retrospectively reviewed. Patients were divided into two groups: upfront resection or resection after downstaging using either chemotherapy alone or selective internal radiation therapy (SIRT) combined with chemotherapy. Survival rates of patients who underwent upfront surgery for ICC were compared with those of patients who underwent surgery after downstaging therapy. Results. A total of 169 patients resected for ICC were included: 137 underwent upfront surgery and 32 received downstaging treatment because their tumor was initially unresectable (13 received chemotherapy, 19 received
Diane Riby and Alessandro D. Mazzotta equally contributed to the data collection, data analysis and wrote the manuscript.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08486-7) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 1 February 2020 K. Boudjema, MD, PhD e-mail: [email protected]
SIRT). Median OS was not different between the two groups: 32.3 months [95% confidence interval (CI) 23.9–40.7] with primary surgery versus 45.9 months (95% CI 32.3–59.4) with downstaging treatment (p = 0.54, log-rank test). In a multivariable Cox regression model, downstaging treatment was not associated with a better or worse prognosis; however, delivery of SIRT as a downstaging treatment was associated with a significant benefit in multivariable analysis (hazard ratio 0.34, 95% CI 0.14–0.84; p = 0.019). Conclusions. Overall survival of patients resected after downstaging treatment was not different compared with the OS of patients resected upfront. Patients should therefore again be discussed with the surgeon following medical treatment. SIRT may be an efficient neoadjuvant therapy in patients with resectable ICC, in order to improve surgical results.
Cholangioc
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