Radiation Segmentectomy and Modified Radiation Lobectomy for Unresectable Early-Stage Intrahepatic Cholangiocarcinoma

Aakash N Gupta; Muhamad Serhal; Andrew C Gordon; Ahmed Gabr; Aparna Kalyan; Laura Kulik; Kent T Sato; Ahsun Riaz; Elias S Hohlastos; Riad Salem; Robert J Lewandowski

doi:10.1016/j.jvir.2024.12.016

Radiation Segmentectomy and Modified Radiation Lobectomy for Unresectable Early-Stage Intrahepatic Cholangiocarcinoma

J Vasc Interv Radiol. 2024 Dec 19:S1051-0443(24)00773-5. doi: 10.1016/j.jvir.2024.12.016. Online ahead of print.

Authors

Affiliations

¹ Department of Radiology, Section of Vascular and Interventional Radiology, Stanford University, 300 Pasteur Drive, H1330, Stanford, CA 94305.
² Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, Chicago, IL.
³ Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago, IL.
⁴ Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, Chicago, IL; Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago, IL; Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL.
⁵ Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, Chicago, IL; Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago, IL; Department of Surgery, Division of Organ Transplantation, Northwestern University, Chicago, IL.
⁶ Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, Chicago, IL; Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago, IL; Department of Surgery, Division of Organ Transplantation, Northwestern University, Chicago, IL. Electronic address: r-lewandowski@northwestern.edu.

PMID: 39709122
DOI: 10.1016/j.jvir.2024.12.016

Abstract

Purpose: To validate the safety and efficacy of radiation segmentectomy (RS) and modified radiation lobectomy (mRL) in intrahepatic cholangiocarcinoma (iCCA) and to evaluate long-term outcomes in patients with unresectable, early-stage iCCA.

Materials and methods: A single-institution, retrospective study of patients with unresectable, solitary iCCA without extrahepatic disease or vascular involvement (stage I) treated with RS and mRL was performed. Fifteen patients met inclusion criteria (median age 65.5 years), including 11 (73%) T1a and 4 (27%) T1b disease. Outcomes included 1) biochemical and clinical toxicities, 2) tumor response by RECIST criteria, 3) time to progression, and 4) overall survival (OS).

Results: Median treatment dose was 308.2 Gy (range: 194.2-879.3). There were no cases of peri-procedural mortality or hepatic deterioration. Grade 3+ clinical toxicities occurred in one patient (7%). The 3-month and best response rates by RECIST were 47% and 60%, respectively. Three patients went on to surgery with explant pathology revealing complete pathologic necrosis. Target lesion progression occurred in 4 patients at a median of 43.4 months. Median OS was 72 months. The 1-, 3-, and 5-year OS were 100%, 73.3%, and 50.3%.

Conclusion: RS and mRL were safe and efficacious in treating unresectable, early-stage iCCA. Overall progression of 47% and 5-year OS of 50% was comparable to surgical resection. RS and mRL may represent viable therapeutic options for patients with early-stage disease deemed surgically unresectable.