Purpose: Patients with liver tumors may not be candidates for curative resection if their future liver remnant (FLR) is inadequate. We aimed to assess outcomes in patients who underwent 90 Y radiation lobectomy (RL) with the intent to hypertrophy the FLR prior to resection. Materials and Methods: With IRB approval and following multidisciplinary tumor board discussion, right lobar þ/segment 4 90 Y treatments were performed prior to right hepaticlobectomy/tri-segmentectomy in patients with hepatic tumor, preserved liver function, but inadequate FLR. Based on 3-D reconstructions, parenchymal/tumor volumes were calculated from pre/post-RL imaging; FLR and %FLR hypertrophy were determined. Common Terminology Criteria for Adverse Events were used to assess post-resection toxicity. Statistical comparisons were made with ANOVA and paired t-tests; p-values o0.05 were considered significant. Results: 11 patients (HCC n¼8, cholangiocarcinoma n¼2, mCRC n¼1) underwent 14 therapies with 90 Y glass microspheres (Therasphere, BTG, London, UK). The median right lobe radiation dose was 141 Gy (111-298 Gy). The median time between RL and imaging to calculate FLR was 36 days (23-124 days), while the median time to resection was 55 days (30-143 days). Median FLR increased significantly after RL [pre: 32% (22-41%); post: 42% (29-58%), po0.01]. The median %FLR hypertrophy was 29% (4-46%); there was no significant change in tumor volume (median decrease 9%). All patients successfully underwent resection; the median hospital stay was 3 days (2-10 days). Transaminase/albumin toxicities were statistically significant in the first post-operative week (po0.01), but were unchanged from baseline 1-month post surgery (AST: p¼0.42, ALT: p¼0.33, albumin: p¼0.29). Grade 3/4 bilirubin elevation was present in only 1 patient at 1 month; the patient had primary sclerosing cholangitis. An HCC patient died 603 days after resection. The median follow-up time of the remaining patients was 465 days (136-1045 days). Conclusion: Radiation lobectomy results in significant hypertrophy of the future liver remnant while treating right lobe tumors; this may allow for safe resection in patients initially presenting with a small FLR.
326 Background: Hilar cholangiocarinoma (Klatskin tumor) is a rare malignancy which is best managed with surgical resection. The majority of patients, however, is unresectable at the time of diagnosis and generally has a poor outcome. The purpose of this study was to retrospectively evaluate the role of chemoradiotherapy (CCRT) for patients with unresectable hilar choloangiocarcinoma at a single institution. Methods: Between 2001 and 2008, a total of 33 patients with unresectable, nonmetastatic hilar cholangiocarcinoma treated at Taipei Veterans General Hospital were reviewed. All patients were to receive 3D-CRT with a median dose of 50.4 Gy (range, 39.6- 60) at 1.8-2 Gy per fraction per day. Sixteen patients also received bolus 5-fluorouracil (5-FU) CCRT (500 mg/m2/d for 3 days repeated every 2 weeks during radiotherapy for 6 weeks). Survivals were estimated by the Kaplan-Meier method and compared by log-rank test. Results: There were 21 males and 12 females, with a median age of 71 years (range, 29 - 81). The median follow-up time was 10.4 months (range, 1 – 42.3) for all patients with the 1- and 2-year survival rates of 45% and 12%, respectively. The median overall survival (OS) and progression-free survival (PFS) were 13.5 months and 10.2 months for the CCRT group, and 10.4 months and 6.5 months for the RT alone group (p = 0.36 and p = 0.28, respectively). Adverse events were similar in thetwo groups with 14 patients (42%) developed grade 1-2 gastrointestinal toxicity during RT. Locoregional progression was observed in 26 patients (79%) and distant metastases in 9 patients (27%). All patients experienced disease progression and had died at time of analysis. Conclusions: The outcome remains poor for unresectable hilar cholangiocarcinoma despite aggressive combined modality treatment. Although not statistically significant, our data showed CCRT provides longer OS and PFS in patients with unresectable hilar cholangiocarcinoma compared to RT alone. Locoregional progression is the main problem for this disease and the efficacy of adding chemotherapy or biologic agents needs to be further investigated. No significant financial relationships to disclose.
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