Intra-arterial Yttrium-90 Radioembolization Combined with Systemic Chemotherapy is a Promising Method for Downstaging Unresectable Huge Intrahepatic Cholangiocarcinoma to Surgical Treatment
Intra-arterial Yttrium-90 Radioembolization Combined with Systemic Chemotherapy is a Promising Method for Downstaging Unresectable Huge Intrahepatic Cholangiocarcinoma to Surgical Treatment
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DOI：
10.1245/s10434-014-4365-3
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发表时间：
2015-09-01
影响因子：
3.7
通讯作者：
Boudjema, K.
中科院分区：
文献类型：
--
作者：
Rayar, M.;Sulpice, L.;Boudjema, K.
为评价钇-90放射性栓塞（Ytt-90）联合化疗对最初不能切除的巨大肝内胆管癌（ICC）的降期疗效和手术结果，在2008年1月至2013年10月期间，对不能切除的ICC进行了化疗和Ytt-90治疗。患者的独特的肿瘤局限于非肝硬化的肝脏，没有肝外转移被认为是潜在的可切除的，每2个月进行评估，可能的二次切除。45例患者接受治疗的不可切除的ICC，10个潜在的可切除的肿瘤，和8个接受手术。最初的不可切除性是由于涉及肝静脉或门静脉的未来肝残，分别在7例和1例。术前治疗导致肿瘤体积显著减小（295 vs. 168 ml，p = 0.02），所有病例均允许R 0切除。3例患者（37.5%）发生Clavien-Dindo 3级或以上并发症，包括2例术后死亡。开始药物治疗后的中位随访时间为15.6 [范围4-40.7]个月，手术后为7.2 [0.13-36.4]个月。在研究期结束时，5例患者仍然存活，其中1例患者在药物治疗开始后40个月（手术后36.4个月）仍然存活; 2例患者出现复发。对于最初无法切除的巨大ICC，Ytt-90放射性栓塞化疗是一种有效的降低分期的方法，可以进行二次切除。
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).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.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.For initially unresectable huge ICCs, chemotherapy with Ytt-90 radioembolization is an effective downstaging method that allows for secondary resectability.