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Intra-arterial Yttrium-90 Radioembolization Combined with Systemic Chemotherapy is a Promising Method for Downstaging Unresectable Huge Intrahepatic Cholangiocarcinoma to Surgical Treatment

  • Hepatobiliary Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the downstaging efficacy of yttrium-90 radioembolization (Ytt-90)-associated with chemotherapy and the results of surgery for initially unresectable huge intrahepatic cholangiocarcinoma (ICC).

Methods

Between January 2008 and October 2013, unresectable ICC were treated with chemotherapy and Ytt-90. Patients with unique tumors localized to noncirrhotic livers and without extrahepatic metastasis were considered to be potentially resectable and were evaluated every 2 months for possible secondary resection.

Results

Forty-five patients were treated for unresectable ICCs; ten had potentially resectable tumors, and eight underwent surgery. Initial unresectability was due to the involvement of the hepatic veins or portal vein of the future liver remnant in seven and one cases, respectively. Preoperative treatment induced significant decreases in tumor volume (295 vs. 168 ml, p = 0.02) and allowed for R0 resection in all cases. Three patients (37.5 %) had Clavien–Dindo grade three or higher complications, including two postoperative deaths. The median follow-ups were 15.6 [range 4–40.7] months after medical treatment initiation and 7.2 [0.13–36.4] months after surgery. At the end of the study period, five patients were still alive, with one patient still alive 40 months after medical treatment initiation (36.4 months after surgery); two patients experienced recurrences.

Conclusions

For initially unresectable huge ICCs, chemotherapy with Ytt-90 radioembolization is an effective downstaging method that allows for secondary resectability.

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Disclosure

E. Garin is a consultant for BTG. The other authors declare no conflict of interest.

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Authors and Affiliations

  1. Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Université de Rennes 1, Rennes, France

    M. Rayar MD, L. Sulpice MD, PhD, G. B. Levi Sandri MD, B. Meunier MD & K. Boudjema MD, PhD

  2. Service d’Oncologie Digestive, Centre Régional de Lutte contre le Cancer, Rennes, France

    J. Edeline MD & E. Boucher MD

  3. Service de Médecine Nucléaire, Centre Régional de Lutte contre le Cancer, Rennes, France

    E. Garin MD, PhD

Authors
  1. M. Rayar MD
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  2. L. Sulpice MD, PhD
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  3. J. Edeline MD
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  4. E. Garin MD, PhD
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  5. G. B. Levi Sandri MD
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  6. B. Meunier MD
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  7. E. Boucher MD
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  8. K. Boudjema MD, PhD
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Corresponding author

Correspondence to K. Boudjema MD, PhD.

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Rayar, M., Sulpice, L., Edeline, J. et al. Intra-arterial Yttrium-90 Radioembolization Combined with Systemic Chemotherapy is a Promising Method for Downstaging Unresectable Huge Intrahepatic Cholangiocarcinoma to Surgical Treatment. Ann Surg Oncol 22, 3102–3108 (2015). https://doi.org/10.1245/s10434-014-4365-3

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  • DOI: https://doi.org/10.1245/s10434-014-4365-3

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