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 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

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

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: To validate the safety and effectiveness 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%) with T1a disease and 4 (27%) with T1b disease. Outcomes included biochemical and clinical toxicities, tumor response by Response Evaluation Criteria in Solid Tumors (RECIST), time to progression, and overall survival (OS). Results: Median treatment dose was 308.2 Gy (range, 194.2–879.3 Gy). There were no cases of periprocedural mortality or hepatic deterioration. Grade 3+ clinical toxicities occurred in 1 patient (7%). The 3-month and best objective 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 rates were 100%, 73.3%, and 50.3%, respectively. Conclusions: RS and mRL were safe and effective in treating unresectable, early-stage iCCA. Overall progression of 47% and 5-year OS of 50% were comparable with those of surgical resection. RS and mRL may represent viable therapeutic options for patients with early-stage disease deemed surgically unresectable.

Original language	English (US)
Pages (from-to)	650-659
Number of pages	10
Journal	Journal of Vascular and Interventional Radiology
Volume	36
Issue number	4
DOIs	https://doi.org/10.1016/j.jvir.2024.12.016
State	Published - Apr 2025

Funding

A.K. reports consulting fees from Genentech, AstraZeneca, and Eisai and payment or honoraria for speaker's bureaus from Genentech and AstraZeneca and for educational events from Tempus and Eisai. L.K. reports research funding from Glycotest, HCC Target; speaker fees from AstraZeneca; participation on a Data Safety Monitoring Board or Advisory Board for AstraZeneca, Eisai, Exelixis, Fujifilm, and Genentech; and participation on a Steering Committee for AstraZeneca and Genentech/Roche. A.R. reports consulting fees from Boston Scientific. E.S.H. reports consulting fees from Penumbra and Stryker. R.S. reports consulting fees from Genentech, Eisai, Merck, Boston Scientific, Cook Medical, Siemens, Autem, AstraZeneca, and Bard. R.J.L. reports grant from National Institutes of Health (R01CA233878); reports consulting fees from ABK Medical, Boston Scientific, BD, Varian, AstraZeneca, Eisai, and Genentech; is President of the Society of Interventional Radiology (SIR); and reports stock or stock options in ABK Medical. The other authors have not identified a conflict of interest.

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

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10.1016/j.jvir.2024.12.016

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Gupta, A. N., Serhal, M., Gordon, A. C., Gabr, A., Kalyan, A., Kulik, L., Sato, K. T., Riaz, A., Hohlastos, E., Salem, R., & Lewandowski, R. J. (2025). Radiation Segmentectomy and Modified Radiation Lobectomy for Unresectable Early-Stage Intrahepatic Cholangiocarcinoma. Journal of Vascular and Interventional Radiology, 36(4), 650-659. https://doi.org/10.1016/j.jvir.2024.12.016

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title = "Radiation Segmentectomy and Modified Radiation Lobectomy for Unresectable Early-Stage Intrahepatic Cholangiocarcinoma",

abstract = "Purpose: To validate the safety and effectiveness 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%) with T1a disease and 4 (27%) with T1b disease. Outcomes included biochemical and clinical toxicities, tumor response by Response Evaluation Criteria in Solid Tumors (RECIST), time to progression, and overall survival (OS). Results: Median treatment dose was 308.2 Gy (range, 194.2–879.3 Gy). There were no cases of periprocedural mortality or hepatic deterioration. Grade 3+ clinical toxicities occurred in 1 patient (7%). The 3-month and best objective 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 rates were 100%, 73.3%, and 50.3%, respectively. Conclusions: RS and mRL were safe and effective in treating unresectable, early-stage iCCA. Overall progression of 47% and 5-year OS of 50% were comparable with those of surgical resection. RS and mRL may represent viable therapeutic options for patients with early-stage disease deemed surgically unresectable.",

author = "Gupta, {Aakash N.} and Muhamad Serhal and Gordon, {Andrew C} and Ahmed Gabr and Aparna Kalyan and Laura Kulik and Sato, {Kent T} and Ahsun Riaz and Elias Hohlastos and Riad Salem and Lewandowski, {Robert J.}",

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year = "2025",

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doi = "10.1016/j.jvir.2024.12.016",

language = "English (US)",

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Gupta, AN, Serhal, M, Gordon, AC, Gabr, A, Kalyan, A , Kulik, L , Sato, KT , Riaz, A, Hohlastos, E, Salem, R & Lewandowski, RJ 2025, 'Radiation Segmentectomy and Modified Radiation Lobectomy for Unresectable Early-Stage Intrahepatic Cholangiocarcinoma', Journal of Vascular and Interventional Radiology, vol. 36, no. 4, pp. 650-659. https://doi.org/10.1016/j.jvir.2024.12.016

TY - JOUR

T1 - Radiation Segmentectomy and Modified Radiation Lobectomy for Unresectable Early-Stage Intrahepatic Cholangiocarcinoma

AU - Gupta, Aakash N.

AU - Serhal, Muhamad

AU - Gordon, Andrew C

AU - Gabr, Ahmed

AU - Kalyan, Aparna

AU - Kulik, Laura

AU - Sato, Kent T

AU - Riaz, Ahsun

AU - Hohlastos, Elias

AU - Salem, Riad

AU - Lewandowski, Robert J.

PY - 2025/4

Y1 - 2025/4

N2 - Purpose: To validate the safety and effectiveness 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%) with T1a disease and 4 (27%) with T1b disease. Outcomes included biochemical and clinical toxicities, tumor response by Response Evaluation Criteria in Solid Tumors (RECIST), time to progression, and overall survival (OS). Results: Median treatment dose was 308.2 Gy (range, 194.2–879.3 Gy). There were no cases of periprocedural mortality or hepatic deterioration. Grade 3+ clinical toxicities occurred in 1 patient (7%). The 3-month and best objective 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 rates were 100%, 73.3%, and 50.3%, respectively. Conclusions: RS and mRL were safe and effective in treating unresectable, early-stage iCCA. Overall progression of 47% and 5-year OS of 50% were comparable with those of surgical resection. RS and mRL may represent viable therapeutic options for patients with early-stage disease deemed surgically unresectable.

AB - Purpose: To validate the safety and effectiveness 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%) with T1a disease and 4 (27%) with T1b disease. Outcomes included biochemical and clinical toxicities, tumor response by Response Evaluation Criteria in Solid Tumors (RECIST), time to progression, and overall survival (OS). Results: Median treatment dose was 308.2 Gy (range, 194.2–879.3 Gy). There were no cases of periprocedural mortality or hepatic deterioration. Grade 3+ clinical toxicities occurred in 1 patient (7%). The 3-month and best objective 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 rates were 100%, 73.3%, and 50.3%, respectively. Conclusions: RS and mRL were safe and effective in treating unresectable, early-stage iCCA. Overall progression of 47% and 5-year OS of 50% were comparable with those of surgical resection. RS and mRL may represent viable therapeutic options for patients with early-stage disease deemed surgically unresectable.

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AN - SCOPUS:85219072000

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JO - Journal of Vascular and Interventional Radiology

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IS - 4

ER -

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

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