DOI: 10.1007/s00259-018-3990-7Pages: 1-11

A MAA-based dosimetric study in patients with intrahepatic cholangiocarcinoma treated with a combination of chemotherapy and 90Y-loaded glass microsphere selective internal radiation therapy

1. Cancer Institute Eugène Marquis, Department of Nuclear Medicine

2. Université de Rennes 1

3. Cancer Institute Eugène Marquis, Department of Medical Imaging

4. U 1099, INSERM

5. LTSI, Université de Rennes 1

6. Cancer Institute Eugène Marquis, Department of Medical Oncology

7. CHU Pontchaillou, Department of Hepatobiliary Surgery

8. CHU Pontchaillou, Department of Hepatology

9. Cancer Institute Eugène Marquis, Department of Medical Information

10. CHU Pontchaillou, Department of Medical Imaging

11. INSERM, INRA, Université de Rennes 1, Université de Bretagne Loire, Nutrition Metabolisms and Cancer (NuMeCan)

Correspondence to:
Etienne Garin
Tel: +33-2-99253075
Email: e.garin@rennes.unicancer.fr

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Abstract

Purpose

Selective internal radiation therapy (SIRT) appears to be an interesting treatment possibility for locally-advanced intrahepatic cholangiocarcinoma (ICC), yet the appropriate dosimetry has never been evaluated in this context.

Methods

We retrospectively studied data from 40 patients treated at our institution with 90Y-loaded glass microsphere SIRT combined with chemotherapy for inoperable ICC as first-line treatment. Macroaggregated albumin (MAA)-based single-photon emission computed tomography (SPECT)/computed tomography (CT) quantitative analysis was used to calculate the tumor dose (TD), healthy-injected liver dose (HILD), and injected liver dose (ILD). Response was evaluated at 3 months using the European Association for the Study of the Liver criteria. Factors associated with response and toxicity were analyzed using univariate analysis.

Results

We assessed a total of 35 patients (five excluded) receiving 55 injections. Mean TD was 322 ± 165Gy and mean HILD was 74 ± 24Gy for a mean ILD of 128 ± 28Gy. All but two lesions responded, with a minimal TD for responding lesions of 158Gy. Six Grade 3–4 permanent liver toxicities were observed. Mean HILD was not associated with liver toxicity (73.2 ± 25.8Gy for patients with liver toxicity and 77.8 ± 16.9Gy for patients without, ns). Only underlying Child-Pugh status (p = 0.0014) and underlying cirrhosis (p = 0.0021) were associated with liver toxicity. Median progression-free survival was 12.7 months and median overall survival (OS) was 28.6 months. Median OS was 52.7 months for patients with Child-Pugh A5 status.

Conclusions

When combined with chemotherapy, SIRT is highly effective, with a TD > 158Gy. Tolerance was good except for the few patients with cirrhosis or Child-Pugh status ≥A6, who exhibited some liver toxicity. Prospective studies are warranted to confirm.

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  • Accepted: Mar 1, 2018
  • Online: Mar 20, 2018

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