Improving patient selection for selective internal radiation therapy of intra-hepatic cholangiocarcinoma: A meta-regression study.
Selective internal radiation therapy (SIRT) is emerging as a potential therapy for unresectable intra-hepatic cholangiocarcinoma (iCCA) able to prolong life-expectancy. Aim of this study was to collect available literature meta-analyse data and results and investigate sources of heterogeneity through a meta-regression approach before suggesting SIRT as a valuable option.



A systematic review of studies published until 1 September 2016 in PubMed and Scopus databases was performed. Patient survival was the primary outcome measure. Meta-analysis was performed using a random-effects model. Meta-regression was applied to investigate relationships existing between clinical and tumour features and the primary outcome.



Nine observational studies were included in the analysis involving 224 patients. The 1-, 2- and 3-year pooled survival estimates were 55.7%, 33.1% and 20.2%. Clinical and tumour characteristics showed medium-to-considerable heterogeneity (I2>50%). Meta-regression analysis showed that determinants of best survivals were the presence of mass-forming iCCA type (median survival=19.9 months vs 8.1 months for the infiltrative type; P=.002) that also accounted for most of the heterogeneity between included studies (residual I2=0); SIRT as first-line therapy (median survival=24 months vs 11.5 months for non-naïve patients; P=.048) and the adoption of concomitant chemotherapy (median survival 19.5 months vs 5.5 months in patients not receiving chemotherapy; P=.042).



There is considerable heterogeneity between studies highlighting that indications for SIRT are extremely varied. To ameliorate SIRT results naïve patients with mass-forming iCCA should be selected as the best candidates with the possibility of adding concomitant standard chemotherapy.
Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
Alessandro
0000-0001-5269-1964
A
Cucchetti
Radiology Unit, Department of Digestive Disease and Internal Medicine, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
Alberta
A
Cappelli
Radiology Unit, Department of Digestive Disease and Internal Medicine, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
Cristina
C
Mosconi
Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.
Jian-Hong
0000-0002-1494-6396
JH
Zhong
Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
Matteo
M
Cescon
Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
Antonio D
AD
Pinna
Radiology Unit, Department of Digestive Disease and Internal Medicine, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
Rita
R
Golfieri
D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
cholangiocarcinoma; meta-analysis; meta-regression; radio-embolization; selective internal radiation therapy