Treatment of recurrent intrahepatic cholangiocarcinoma
Institut National de la Santé et de la Recherche Médicale (INSERM) UMR991 'Foie, Métabolismes et Cancer', Université de Rennes 1, Rennes, France. British Journal of Surgery
(Impact Factor: 5.54).
12/2012; 99(12):1711-7. DOI: 10.1002/bjs.8953
The aims of this study were to evaluate risk factors for recurrence following hepatectomy with curative intent for intrahepatic cholangiocarcinoma (ICC), and predictors of survival after intrahepatic recurrence.
All patients with ICC who underwent liver resection between January 1997 and August 2011 in a single centre were analysed retrospectively. Clinicopathological factors likely to influence recurrence and postrecurrence survival were assessed by univariable and multivariable analysis.
A total of 87 patients were analysed. R0 resection was achieved in 65 patients (75 per cent). Eighty-three patients survived more than 1 month after resection. Median survival was 33 months, with 1-, 3- and 5-year actuarial survival rates of 79, 47 and 31 per cent respectively. Recurrence occurred in 45 (54 per cent) of the 83 patients, most frequently in the liver (25 patients). Satellite nodules (odds ratio (OR) 8·17, 95 per cent confidence interval 1·38 to 48·53; P = 0·021), hilar lymph node metastases (OR 5·24, 1·07 to 25·75; P = 0·041) and perineural invasion (OR 9·68, 1·07 to 87·54; P = 0·043) were identified as independent risk factors for recurrence. Repeat hepatectomy (P = 0·003) and intra-arterial yttrium-90 radiotherapy (P = 0·048) were associated with longer survival after intrahepatic recurrence.
Satellite nodules, hilar lymph node metastases and perineural invasion are risk factors for recurrence following resection with curative intent for ICC. Repeat hepatectomy and labelled yttrium-90 radiotherapy may improve survival after intrahepatic recurrence. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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Available from: Otto Kollmar
- "SIRT is a radioembolization procedure which is considered to be an effective liver-directed therapy with a favorable therapeutic ratio that offers meaningful benefits for selected patients [26,27]. SIRT is able to improve survival after intrahepatic recurrence of ICC . Of interest, the antitumor effect of SIRT is rather related to radiation than to embolization . "
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ABSTRACT: Intra- or extrahepatic cholangiocarcinomas are the second most common primary liver malignancies behind hepatocellular carcinoma. Whereas the incidence for intrahepatic cholangiocarcinoma is rising, the occurrence of extrahepatic cholangiocarcinoma is trending downwards. The treatment of choice for intrahepatic cholangiocarcinoma remains liver resection. However, a case of liver resection after selective internal radiation therapy in order to treat a recurrent intrahepatic cholangiocarcinoma in a transplant liver is unknown in the literature so far. Herein, we present a case of a patient undergoing liver transplantation for Wilson's disease with an accidental finding of an intrahepatic cholangiocarcinoma within the explanted liver. Due to a recurrent intrahepatic cholangiocarcinoma after liver transplantation, a selective internal radiation therapy with yttrium-90 microspheres was performed followed by right hemihepatectomy. Four years later, the patient is tumor-free and in a healthy condition.
World Journal of Surgical Oncology 07/2014; 12(1):198. DOI:10.1186/1477-7819-12-198 · 1.41 Impact Factor
Available from: Michael Vouche
- "In our study, the incidence of disease progression in the untreated left lobe was 2/8 in CRC and 2/8 in CC patients at any time during follow-up. As comparison, the literature reports 25% of metastatic recurrence in the FLR 3 weeks after PVE (CRC) and a disease-free survival of 46%, 1-year after hepatic resection for CC  . In contrast to the time-dependent reporting of FLRs in this report, comparison with the literature is difficult, since authors usually report a one-time static FLR following PVE. "
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ABSTRACT: Portal vein embolization (PVE) is a standard technique for patients not amenable to liver resection due to small future liver remnant ratio (FLR). Radiation lobectomy (RL) with Y90-loaded microspheres (Y90) is hypothesized to induce comparable volumetric changes in liver lobes, while potentially controlling the liver tumor and limiting tumor progression in the untreated lobe. We aimed to test this concept by performing a comprehensive time-dependent analysis of liver volumes following radioembolization.
83 patients with right unilobar disease with hepatocellular carcinoma (HCC; N=67), cholangiocarcinoma (CC; N=8) or colorectal cancer (CRC; N=8) were treated by Y90 RL. The total liver volume, lobar (parenchymal) and tumor volumes, FLR and percentage of FLR hypertrophy from baseline (%FLR hypertrophy) were assessed on pre- and post-Y90 CT/MRI scans in a dynamic fashion.
Right lobe atrophy (p=0.003), left lobe hypertrophy (p<0.001) and FLR hypertrophy (p<0.001) were observed 1 month after Y90 and was consistent at all follow-up timepoints. Median%FLR hypertrophy reached 45% (5-186) after 9 months (p<0.001). The median maximal%FLR hypertrophy was 26% (-14→86). Portal vein thrombosis was correlated to%FLR hypertrophy (p=0.02). Median Child-Pugh score worsening (6→7) was seen at 1 to 3 months (p=0.03) and 3 to 6 months (p=0.05) after treatment. Five patients underwent successful right lobectomy (HCC N=3, CRC N=1, CC N=1) and 6 HCCs were transplanted.
Radiation lobectomy by Y90 is a safe and effective technique to hypertrophy the FLR. Volumetric changes are comparable (albeit slightly slower) to PVE while the right lobe tumor is treated synchronously. This novel technique is of particular interest in the bridge-to-resection setting.
Journal of Hepatology 06/2013; 59(5). DOI:10.1016/j.jhep.2013.06.015 · 11.34 Impact Factor
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ABSTRACT: Cholangiocarcinoma is a malignant neoplasm that originates from biliary epithelial cells. Complete tumor resection remains the most effective treatment of intra-hepatic or perihilar cholangiocarcinomas (PHCs). The objectives of this are to update and discuss methods that are likely to increase the resectability of cholangiocarcinomas, and to define the limits beyond which the risks of the treatments outweigh their benefits. We analyzed intra-hepatic cholangiocarcinomas and PHCs separately to determine the site of origin and the resectability of the tumor. We discussed the site at which to perform hepatic optimization prior to surgery, and whether liver transplantation might affect cholangiocarcinoma treatment.
10/2013; 66(2). DOI:10.1007/s13304-013-0235-y
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