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Downstaging with Radioembolization or Chemotherapy for Initially Unresectable Intrahepatic Cholangiocarcinoma

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

Abstract

Objective

The aim of this retrospective study was to compare the outcomes of patients resected for intrahepatic cholangiocarcinoma (ICC) with upfront surgery or after downstaging treatment.

Methods

All consecutive patients with ICC between January 1997 and November 2017 were included in a single-center database and retrospectively reviewed. Patients were divided into two groups: upfront resection or resection after downstaging using either chemotherapy alone or selective internal radiation therapy (SIRT) combined with chemotherapy. Survival rates of patients who underwent upfront surgery for ICC were compared with those of patients who underwent surgery after downstaging therapy.

Results

A total of 169 patients resected for ICC were included: 137 underwent upfront surgery and 32 received downstaging treatment because their tumor was initially unresectable (13 received chemotherapy, 19 received SIRT). Median OS was not different between the two groups: 32.3 months [95% confidence interval (CI) 23.9–40.7] with primary surgery versus 45.9 months (95% CI 32.3–59.4) with downstaging treatment (p = 0.54, log-rank test). In a multivariable Cox regression model, downstaging treatment was not associated with a better or worse prognosis; however, delivery of SIRT as a downstaging treatment was associated with a significant benefit in multivariable analysis (hazard ratio 0.34, 95% CI 0.14–0.84; p = 0.019).

Conclusions

Overall survival of patients resected after downstaging treatment was not different compared with the OS of patients resected upfront. Patients should therefore again be discussed with the surgeon following medical treatment. SIRT may be an efficient neoadjuvant therapy in patients with resectable ICC, in order to improve surgical results.

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Acknowledgments

We are grateful to Peter Tucker for language editing assistance.

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Author notes

  1. Diane Riby and Alessandro D. Mazzotta equally contributed to the data collection, data analysis and wrote the manuscript.

Authors and Affiliations

  1. Departement of Medical Oncology, Centre Eugène Marquis, Rennes, France

    Diane Riby MD, Heloise Bourien MD & Julien Edeline MD, PhD

  2. Departement of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes, Rennes, France

    Alessandro D. Mazzotta MD, Damien Bergeat MD, Lucas Verdure MD, Laurent Sulpice MD, PhD & Karim Boudjema MD, PhD

  3. Departement of Hepatogastroenterology, CHU Rennes, University of Rennes, Rennes, France

    Astrid Lièvre MD, PhD

  4. Departement of Interventional Radiology, Centre Eugène Marquis, Rennes, France

    Yan Rolland MD

  5. Departement of Nuclear Medicine, Centre Eugène Marquis, Rennes, France

    Etienne Garin MD, PhD

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  1. Diane Riby MD
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Contributions

DR and ADM contributed equally to the data collection and data analysis, and wrote the manuscript. KB and JE designed and supervised the project. All authors discussed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Karim Boudjema MD, PhD.

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Diane Riby, Alessandro D. Mazzotta, Damien Bergeat, Lucas Verdure, Laurent Sulpice, Heloise Bourien, Astrid Lièvre, Yan Rolland, Etienne Garin, Karim Boudjema, and Julien Edeline declare there are no conflicts of interest regarding the publication of this article.

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Riby, D., Mazzotta, A.D., Bergeat, D. et al. Downstaging with Radioembolization or Chemotherapy for Initially Unresectable Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 27, 3729–3737 (2020). https://doi.org/10.1245/s10434-020-08486-7

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  • DOI: https://doi.org/10.1245/s10434-020-08486-7

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