Tesi etd-07182018-102227 |
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Tipo di tesi
Tesi di specializzazione (5 anni)
Autore
LORENZONI, GIULIA
URN
etd-07182018-102227
Titolo
Y90-radioembolization in unresectable intra-hepatic cholangiocarcinoma: results of an Italian multicenter retrospective study
Dipartimento
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Corso di studi
RADIODIAGNOSTICA
Relatori
relatore Prof. Caramella, Davide
correlatore Dott.ssa Bargellini, Irene
correlatore Dott.ssa Bargellini, Irene
Parole chiave
- Cholangiocarcinoma
- interventional oncology
- radioembolization
- RECIST
Data inizio appello
08/08/2018
Consultabilità
Non consultabile
Data di rilascio
08/08/2088
Riassunto
Abstract
Purpose: To retrospectively evaluate the clinical outcomes of Y90 transarterial radioembolization (RE) in patients with unresectable intrahepatic cholangiocarcinoma (ICC).
Materials and Methods: This is a retrospective multicenter study involving 81 consecutive patients (49 male, mean age 62.4 ± 11.8 years) with unresectable biopsy-proven ICC, who underwent RE using resin spheres, in three Italian tertiary referral centers. Preprocedural clinical and tumoral variables were collected. Tumor response was assessed using RECIST 1.1. Overall survival (OS) was calculated from initial diagnosis and from first RE.
Results: The series included 28 (34.6%) naïve patients; in the remaining cases RE was performed as consolidation (n=19, 23.4%) or salvage therapy (34, 42%). Median OS was 14.5 months (95% CI: 11.1-16.9) and it did not significantly differ according to the indications to treatment. Radiological tumor response was available in 79 patients; objective response and disease control rates were 41.8% and 83.6%, respectively. On follow up, three patients were resected, while 12 patients underwent other loco-regional therapies, including RE (8 patients), radiofrequency ablation (1 case), transarterial (chemo) embolization (3 cases) and endobiliary brachytherapy (1 patient). Median OS was 14.5 months and was significantly (P<0.05) affected by the tumor load (in terms of number of lesions and percentage of liver involvement), baseline values of Ca19.9, neutrophil-to-lymphocyte (N/L) ratio and radiological tumor response.
At multivariate analysis, tumor extension >50% of liver volume, N/L ratio ≥ 3 and radiological progression as best response were all confirmed to be independently and negatively associated to OS.
Conclusions: Our multicenter retrospective analysis of a relatively large series of patients confirms safety and efficacy of RE in unresectable ICC; tumor extension, tumor markers and radiological response are independent variables affecting survival.
Purpose: To retrospectively evaluate the clinical outcomes of Y90 transarterial radioembolization (RE) in patients with unresectable intrahepatic cholangiocarcinoma (ICC).
Materials and Methods: This is a retrospective multicenter study involving 81 consecutive patients (49 male, mean age 62.4 ± 11.8 years) with unresectable biopsy-proven ICC, who underwent RE using resin spheres, in three Italian tertiary referral centers. Preprocedural clinical and tumoral variables were collected. Tumor response was assessed using RECIST 1.1. Overall survival (OS) was calculated from initial diagnosis and from first RE.
Results: The series included 28 (34.6%) naïve patients; in the remaining cases RE was performed as consolidation (n=19, 23.4%) or salvage therapy (34, 42%). Median OS was 14.5 months (95% CI: 11.1-16.9) and it did not significantly differ according to the indications to treatment. Radiological tumor response was available in 79 patients; objective response and disease control rates were 41.8% and 83.6%, respectively. On follow up, three patients were resected, while 12 patients underwent other loco-regional therapies, including RE (8 patients), radiofrequency ablation (1 case), transarterial (chemo) embolization (3 cases) and endobiliary brachytherapy (1 patient). Median OS was 14.5 months and was significantly (P<0.05) affected by the tumor load (in terms of number of lesions and percentage of liver involvement), baseline values of Ca19.9, neutrophil-to-lymphocyte (N/L) ratio and radiological tumor response.
At multivariate analysis, tumor extension >50% of liver volume, N/L ratio ≥ 3 and radiological progression as best response were all confirmed to be independently and negatively associated to OS.
Conclusions: Our multicenter retrospective analysis of a relatively large series of patients confirms safety and efficacy of RE in unresectable ICC; tumor extension, tumor markers and radiological response are independent variables affecting survival.
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