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Research ArticleClinical Investigation

Real-Life Experience in the Treatment of Intrahepatic Cholangiocarcinoma by 90Y Radioembolization: A Multicenter Retrospective Study

Benedikt M. Schaarschmidt, Roman Kloeckner, Thomas Dertnig, Aydin Demircioglu, Lukas Müller, Timo Alexander Auer, Daniel Pinto dos Santos, Verena Steinle, Matthias Miederer, Bernhard Gebauer, Sonia Radunz, Stefan Kasper, Manuel Weber and Jens Theysohn
Journal of Nuclear Medicine April 2023, 64 (4) 529-535; DOI: https://doi.org/10.2967/jnumed.122.264598
Benedikt M. Schaarschmidt
1Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany;
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Roman Kloeckner
2Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany;
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Thomas Dertnig
1Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany;
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Aydin Demircioglu
1Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany;
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Lukas Müller
2Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany;
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Timo Alexander Auer
3Department of Radiology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany;
4Berlin Institute of Health, Berlin, Germany;
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Daniel Pinto dos Santos
5Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany;
6Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany;
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Verena Steinle
7Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany;
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Matthias Miederer
8Clinic of Nuclear Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany;
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Bernhard Gebauer
3Department of Radiology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany;
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Sonia Radunz
9Department of General, Visceral, and Transplant Surgery, University Hospital Essen, Essen, Germany;
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Stefan Kasper
10Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; and
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Manuel Weber
11Clinic of Nuclear Medicine, University Hospital Essen, Essen, Germany
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Jens Theysohn
1Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany;
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  • FIGURE 1.
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    FIGURE 1.

    Flowchart of analyzed patients. CCA = cholangiocarcinoma; HCC = hepatocellular carcinoma.

  • FIGURE 2.
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    FIGURE 2.

    A 64-y-old man with stage 4 iCCA with lymph node metastases. (A and B) Initial MRI shows hypovascularized tumor in right liver lobe (A, arrow), with faint contrast agent uptake in preinterventional angiography with subsequent 99mTc-macroaggregated albumin injection (B, arrow). Radioembolization of right hepatic artery with 4.64 GBq was performed 27 d after 99mTc-macroaggregated albumin injection. (C) Postinterventional MRI 126 d after radioembolization showed partial tumor response (arrow). Patient died after 176 d.

  • FIGURE 3.
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    FIGURE 3.

    Kaplan–Meier survival curves for different tumor characteristics in analyzed cohort: tumor type (A), hepatic tumor burden (B), and tumor vascularization pattern (C).

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    FIGURE 4.

    Kaplan–Meier survival curves for different baseline characteristics in analyzed cohort: extrahepatic metastases (A), liver cirrhosis (B), and ascites (C).

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    FIGURE 5.

    Kaplan–Meier survival curves for different treatment lines in analyzed cohort.

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    FIGURE 6.

    Forest plot for multivariable Cox regression analysis. dof = degrees of freedom.

Tables

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    TABLE 1.

    Baseline Characteristics of All Radioembolizations

    Characteristic%n
    Initial UICC tumor stage
     I1.42
     II2129
     IIIa14.520
     IIIb38.553
     IV20.328
     Unknown4.36
    Tumor type
     Mass-forming58.781
     Diffuse intrahepatic39.955
     Unknown1.42
    Tumor vascularization
     Hypervascularized34.848
     Hypovascularized36.250
     Mixed appearance22.531
     Unknown6.59
    Hepatic tumor burden
     <25%52.272
     25%–50%25.435
     >50%15.221
     Unknown7.210
    Distant metastases at time of radioembolization
     Yes43.560
      Lymph nodes10.114
      Peritoneum7.210
      Pancreas0.71
      Lung10.915
      Bone5.17
      Brain2.23
     No56.578
    Liver cirrhosis at time of radioembolization
     Yes15.922
     No83.4115
     Unknown0.71
    Ascites at time of radioembolization
     Yes23.933
     No76.1105
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    TABLE 2.

    Treatments Before Radioembolization

    Treatment%n
    Prior therapy
     Yes84.6103
      Hepatic surgery31.944
      Extrahepatic surgery3.65
      Radiation2.94
      Radioembolization7.210
      TACE/TAE/HAI5.17
      Local ablation (MWA/RFA)5.88
      Chemotherapy62.386
      Tyrosine kinase inhibitor therapy2.23
     No25.435
    First-line radioembolization25.435
    Second-line radioembolization38.453
    Salvage radioembolization36.250
    • HAI = hepatic artery infusion; MWA = microwave ablation; RFA = radiofrequency ablation.

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Journal of Nuclear Medicine: 64 (4)
Journal of Nuclear Medicine
Vol. 64, Issue 4
April 1, 2023
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Real-Life Experience in the Treatment of Intrahepatic Cholangiocarcinoma by 90Y Radioembolization: A Multicenter Retrospective Study
Benedikt M. Schaarschmidt, Roman Kloeckner, Thomas Dertnig, Aydin Demircioglu, Lukas Müller, Timo Alexander Auer, Daniel Pinto dos Santos, Verena Steinle, Matthias Miederer, Bernhard Gebauer, Sonia Radunz, Stefan Kasper, Manuel Weber, Jens Theysohn
Journal of Nuclear Medicine Apr 2023, 64 (4) 529-535; DOI: 10.2967/jnumed.122.264598

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Real-Life Experience in the Treatment of Intrahepatic Cholangiocarcinoma by 90Y Radioembolization: A Multicenter Retrospective Study
Benedikt M. Schaarschmidt, Roman Kloeckner, Thomas Dertnig, Aydin Demircioglu, Lukas Müller, Timo Alexander Auer, Daniel Pinto dos Santos, Verena Steinle, Matthias Miederer, Bernhard Gebauer, Sonia Radunz, Stefan Kasper, Manuel Weber, Jens Theysohn
Journal of Nuclear Medicine Apr 2023, 64 (4) 529-535; DOI: 10.2967/jnumed.122.264598
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Keywords

  • cholangiocarcinoma
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