Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 3/2019

01-03-2019 | Original Article

Yttrium-90 glass microspheres radioembolization (RE) for biliary tract cancer: a large single-center experience

Authors: Héloïse Bourien, Xavier Palard, Yan Rolland, Fanny Le Du, Luc Beuzit, Thomas Uguen, Samuel Le Sourd, Marc Pracht, Vincent Manceau, Astrid Lièvre, Karim Boudjema, Etienne Garin, Julien Edeline

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 3/2019

Login to get access

Abstract

Purpose

Radioembolization (RE) is a promising treatment option for biliary tract cancers (BTC). We report here the largest series to date using this treatment modality.

Methods

We retrospectively studied data from 64 patients treated outside prospective clinical trial at our institution. We studied baseline characteristics as potential prognostic factors. We studied dose delivered to the tumor as predictive factors of outcomes in patients not receiving concomitant chemotherapy.

Results

The Progression-Free Survival and Overall Survival (OS) were 7.6 months [95% Confidence Interval (CI): 4.6–10.6] and 16.4 months [95% CI: 7.8–25.0] in the whole cohort. The factors independently associated with OS in multivariable analysis were the primary localization of ICC (HR = 0.27, 95% CI: 0.11–0.68, p = 0.005) and a PS > 0 (HR = 2.21, 95% CI: 1.11–4.38, p = 0.024). During follow-up, 12 patients (19%) underwent surgery following downstaging, with a median OS of 51.9 months. In patients not treated with concomitant chemotherapy (n = 31), OS was significantly higher in patients with a dose delivered to the tumor 260Gy or higher than in patients with a dose delivered to the tumor lower than 260Gy (median 28.2 vs 11.4 months, log-rank p = 0.019).

Conclusion

Our results confirm that RE is a promising treatment modality in BTC. A high proportion of patients could be downstaged to surgery, with promising long-term survival. Dose delivered to the tumor correlated with clinical outcomes when chemotherapy was not used concomitantly.
Literature
1.
Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part III: liver, biliary tract, and pancreas. Gastroenterology. 2009;136:1134–44.CrossRefPubMed
2.
Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet Lond Engl. 2014;383:2168–79.CrossRef
3.
Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362:1273–81.CrossRefPubMed
4.
Okusaka T, Nakachi K, Fukutomi A, Mizuno N, Ohkawa S, Funakoshi A, et al. Gemcitabine alone or in combination with cisplatin in patients with biliary tract cancer: a comparative multicentre study in Japan. Br J Cancer. 2010;103:469–74.CrossRefPubMedPubMedCentral
5.
Valle JW, Furuse J, Jitlal M, Beare S, Mizuno N, Wasan H, et al. Cisplatin and gemcitabine for advanced biliary tract cancer: a meta-analysis of two randomised trials. Ann Oncol. 2014;25:391–8.CrossRefPubMed
6.
Mosconi C, Gramenzi A, Ascanio S, Cappelli A, Renzulli M, Pettinato C, et al. Yttrium-90 radioembolization for unresectable/recurrent intrahepatic cholangiocarcinoma: a survival, efficacy and safety study. Br J Cancer. 2016;115:297–302.CrossRefPubMedPubMedCentral
7.
Soydal C, Kucuk ON, Bilgic S, Ibis E. Radioembolization with (90)Y resin microspheres for intrahepatic cholangiocellular carcinoma: prognostic factors. Ann Nucl Med. 2016;30:29–34.CrossRefPubMed
8.
Edeline J, Du FL, Rayar M, Rolland Y, Beuzit L, Boudjema K, et al. Glass microspheres 90Y selective internal radiation therapy and chemotherapy as first-line treatment of intrahepatic cholangiocarcinoma. Clin Nucl Med. 2015;40:851–5.CrossRefPubMed
9.
Filippi L, Pelle G, Cianni R, Scopinaro F, Bagni O. Change in total lesion glycolysis and clinical outcome after (90)Y radioembolization in intrahepatic cholangiocarcinoma. Nucl Med Biol. 2015;42:59–64.CrossRefPubMed
10.
Camacho JC, Kokabi N, Xing M, Prajapati HJ, El-Rayes B, Kim HS. Modified response evaluation criteria in solid tumors and European Association for the Study of the liver criteria using delayed-phase imaging at an early time point predict survival in patients with unresectable intrahepatic cholangiocarcinoma following yttrium-90 radioembolization. J Vasc Interv Radiol JVIR. 2014;25:256–65.CrossRefPubMed
11.
Mouli S, Memon K, Baker T, Benson AB, Mulcahy MF, Gupta R, et al. Yttrium-90 Radioembolization for intrahepatic cholangiocarcinoma: safety, response. and Survival Analysis J Vasc Interv Radiol. 2013;24:1227–34.CrossRefPubMed
12.
Hoffmann R-T, Paprottka PM, Schön A, Bamberg F, Haug A, Dürr E-M, et al. Transarterial hepatic Yttrium-90 Radioembolization in patients with Unresectable intrahepatic cholangiocarcinoma: factors associated with prolonged survival. Cardiovasc Intervent Radiol. 2012;35:105–16.CrossRefPubMed
13.
Saxena A, Bester L, Chua TC, Chu FC, Morris DL. Yttrium-90 radiotherapy for Unresectable intrahepatic cholangiocarcinoma: a preliminary assessment of this novel treatment option. Ann Surg Oncol. 2010;17:484–91.CrossRefPubMed
14.
Jia Z, Paz-Fumagalli R, Frey G, Sella DM, McKinney JM, Wang W. Resin-based Yttrium-90 microspheres for unresectable and failed first-line chemotherapy intrahepatic cholangiocarcinoma: preliminary results. J Cancer Res Clin Oncol. 2017;143:481–9.CrossRefPubMed
15.
Reimer P, Virarkar MK, Binnenhei M, Justinger M, Schön MR, Tatsch K. Prognostic factors in overall survival of patients with Unresectable intrahepatic cholangiocarcinoma treated by means of Yttrium-90 Radioembolization: results in therapy-Naïve patients. Cardiovasc Intervent Radiol 2018.
16.
Swinburne NC, Biederman DM, Besa C, Tabori NE, Fischman AM, Patel RS, et al. Radioembolization for Unresectable intrahepatic cholangiocarcinoma: review of safety, response evaluation criteria in solid tumors 1.1 imaging response and survival. Cancer Biother Radiopharm. 2017;32:161–8.CrossRefPubMed
17.
Shaker TM, Chung C, Varma MK, Doherty MG, Wolf AM, Chung MH, et al. Is there a role for Ytrrium-90 in the treatment of unresectable and metastatic intrahepatic cholangiocarcinoma? Am J Surg. 2018;215:467–70.CrossRefPubMed
18.
Cucchetti A, Cappelli A, Mosconi C, Zhong J-H, Cescon M, Pinna AD, et al. Improving patient selection for selective internal radiation therapy of intra-hepatic cholangiocarcinoma: a meta-regression study. Liver Int off J Int Assoc study. Liver. 2017;37:1056–64.CrossRef
19.
Garin E, Lenoir L, Edeline J, Laffont S, Mesbah H, Porée P, et al. Boosted selective internal radiation therapy with 90Y-loaded glass microspheres (B-SIRT) for hepatocellular carcinoma patients: a new personalized promising concept. Eur J Nucl Med Mol Imaging. 2013;40:1057–68.CrossRefPubMedPubMedCentral
20.
Garin E. Radioembolisation of hepatocellular carcinoma patients using 90Y-labelled microspheres: towards a diffusion of the technique? Eur J Nucl Med Mol Imaging. 2011;38:2114–6.CrossRefPubMed
21.
Manceau V, Palard X, Rolland Y, Pracht M, Le Sourd S, Laffont S, et al. A MAA-based dosimetric study in patients with intrahepatic cholangiocarcinoma treated with a combination of chemotherapy and90Y-loaded glass microsphere selective internal radiation therapy. Eur J Nucl Med Mol Imaging. 2018.
22.
Salem R, Lewandowski RJ, Gates VL, Nutting CW, Murthy R, Rose SC, et al. Research reporting standards for radioembolization of hepatic malignancies. J Vasc Interv Radiol JVIR. 2011;22:265–78.CrossRefPubMed
23.
Garin E, Lenoir L, Rolland Y, Laffont S, Pracht M, Mesbah H, et al. Effectiveness of quantitative MAA SPECT/CT for the definition of vascularized hepatic volume and dosimetric approach: phantom validation and clinical preliminary results in patients with complex hepatic vascularization treated with yttrium-90-labeled microspheres. Nucl Med Commun. 2011;32:1245–55.CrossRefPubMed
24.
Zhu C-P, Shi J, Chen Y-X, Xie W-F, Lin Y. Gemcitabine in the chemoradiotherapy for locally advanced pancreatic cancer: a meta-analysis. Radiother Oncol J Eur Soc Ther. Radiol Oncol. 2011;99:108–13.CrossRef
25.
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer Oxf Engl 1990. 2009;45:228–47.
26.
Beuzit L, Edeline J, Brun V, Ronot M, Guillygomarc’h A, Boudjema K, et al. Comparison of Choi criteria and response evaluation criteria in solid tumors (RECIST) for intrahepatic cholangiocarcinoma treated with glass-microspheres Yttrium-90 selective internal radiation therapy (SIRT). Eur J Radiol. 2016;85:1445–52.CrossRefPubMed
27.
Primrose J et al. Adjuvant capecitabine for biliary tract cancer: The BILCAP randomized study. J Clin Oncol ASCO Meet Abstr. 2017;35:Abstr 4006.
28.
Edeline J et al. Adjuvant GEMOX for biliary tract cancer: updated relapse-free survival and first overall survival results of the randomized PRODIGE 12-ACCORD 18 (UNICANCER GI) phase III trial. ESMO Conf. 2017;Abstr LBA 29.
29.
Rayar M, Sulpice L, Edeline J, Garin E, Levi Sandri GB, Meunier B, 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 2015.
30.
Spolverato G, Yakoob MY, Kim Y, Alexandrescu S, Marques HP, Lamelas J, et al. The impact of surgical margin status on long-term outcome after resection for intrahepatic cholangiocarcinoma. Ann Surg Oncol. 2015;22:4020–8.CrossRefPubMed
31.
Farges O, Fuks D, Boleslawski E, Le Treut Y-P, Castaing D, Laurent A, et al. Influence of surgical margins on outcome in patients with intrahepatic cholangiocarcinoma: a multicenter study by the AFC-IHCC-2009 study group. Ann Surg. 2011;254:824–30.CrossRefPubMed
32.
Wright GP, Perkins S, Jones H, Zureikat AH, Marsh JW, Holtzman MP, et al. Surgical resection does not improve survival in multifocal intrahepatic cholangiocarcinoma: a comparison of surgical resection with intra-arterial therapies. Ann Surg Oncol. 2018;25:83–90.CrossRefPubMed
33.
Edeline J, Coulouarn C, Crouzet L, Pracht M, Lepareur N, Clément B, et al. Gemcitabine and oxaliplatin, but not sorafenib or paclitaxel, have a synergistic effect with yttrium-90 in reducing hepatocellular carcinoma and cholangiocarcinoma cell line viability. J Vasc Interv Radiol JVIR. 2015;26:1874–1878.e2.CrossRefPubMed
34.
Garin E, Rolland Y, Laffont S, Edeline J. Clinical impact of (99m)Tc-MAA SPECT/CT-based dosimetry in the radioembolization of liver malignancies with (90)Y-loaded microspheres. Eur J Nucl Med Mol Imaging. 2016;43:559–75.CrossRefPubMed
35.
Edeline J et al. Selective Internal Radiation Therapy (SIRT) with Yttrium-90-glass-microspheres plus chemotherapy in first-line treatment of advanced cholangiocarcinoma (MISPHEC study). ESMO Conf. 2017;Abstr 771P.
36.
Kloeckner R, Ruckes C, Kronfeld K, Wörns MA, Weinmann A, Galle PR, et al. Selective internal radiotherapy (SIRT) versus transarterial chemoembolization (TACE) for the treatment of intrahepatic cholangiocellular carcinoma (CCC): study protocol for a randomized controlled trial. Trials. 2014;15:311.CrossRefPubMedPubMedCentral
Metadata
Title
Yttrium-90 glass microspheres radioembolization (RE) for biliary tract cancer: a large single-center experience
Authors
Héloïse Bourien
Xavier Palard
Yan Rolland
Fanny Le Du
Luc Beuzit
Thomas Uguen
Samuel Le Sourd
Marc Pracht
Vincent Manceau
Astrid Lièvre
Karim Boudjema
Etienne Garin
Julien Edeline
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 3/2019
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-018-4199-5

Other articles of this Issue 3/2019

European Journal of Nuclear Medicine and Molecular Imaging 3/2019 Go to the issue

Original Article

Personalized 177Lu-octreotate peptide receptor radionuclide therapy of neuroendocrine tumours: initial results from the P-PRRT trial

Original Article

Comparison of 18F-GE-180 and dynamic 18F-FET PET in high grade glioma: a double-tracer pilot study

Original Article

Salvage peptide receptor radionuclide therapy with [177Lu-DOTA,Tyr3]octreotate in patients with bronchial and gastroenteropancreatic neuroendocrine tumours

Original Article

FET PET reveals considerable spatial differences in tumour burden compared to conventional MRI in newly diagnosed glioblastoma

Image of the Month

Ectopic corticotropin-releasing hormone syndrome caused by pancreatic neuroendocrine tumor localized by 68Ga-DOTATATE PET/CT

Original Article

Highly favourable outcomes with peptide receptor radionuclide therapy (PRRT) for metastatic rectal neuroendocrine neoplasia (NEN)