Resection Postradioembolization in Patients With Single Large Hepatocellular Carcinoma

OBJECTIVE

The aim of this study was to evaluate the efficacy of yttrium-90 transarterial radioembolization (TARE) to convert to resection initially unresectable, single, large (≥5 cm) hepatocellular carcinoma (HCC).

BACKGROUND

TARE can downsize cholangiocarcinoma to resection but its role in HCC resectability remains debatable.

METHODS

All consecutive patients with a single large HCC treated between 2015 and 2020 in a single tertiary center were reviewed. When indicated, patients were either readily resected (upfront surgery) or underwent TARE. TARE patients were converted to resection (TARE surgery) or not (TARE-only). To further assess the effect of TARE on the long-term and short-term outcomes, a propensity score matching analysis was performed.

RESULTS

Among 216 patients, 144 (66.7%) underwent upfront surgery. Among 72 TARE patients, 20 (27.7%) were converted to resection. TARE-surgery patients received a higher mean yttrium-90 dose that the 52 remaining TARE-only patients (211.89±107.98 vs 128.7±36.52 Gy, P <0.001). Postoperative outcomes between upfront-surgery and TARE-surgery patients were similar. In the unmatched population, overall survival at 1, 3, and 5 years was similar between upfront-surgery and TARE-surgery patients (83.0%, 60.0%, 47% vs 94.0%, 86.0%, 55.0%, P =0.43) and compared favorably with TARE-only patients (61.0%, 16.0% and 9.0%, P <0.0001). After propensity score matching, TARE-surgery patients had significantly better overall survival than upfront-surgery patients ( P =0.021), while disease-free survival was similar ( P =0.29).

CONCLUSION

TARE may be a useful downstaging treatment for unresectable localized single large HCC providing comparable short-term and long-term outcomes with readily resectable tumors.

Downstaging with Radioembolization or Chemotherapy for Initially Unresectable Intrahepatic Cholangiocarcinoma

OBJECTIVE

The aim of this retrospective study was to compare the outcomes of patients resected for intrahepatic cholangiocarcinoma (ICC) with upfront surgery or after downstaging treatment.

METHODS

All consecutive patients with ICC between January 1997 and November 2017 were included in a single-center database and retrospectively reviewed. Patients were divided into two groups: upfront resection or resection after downstaging using either chemotherapy alone or selective internal radiation therapy (SIRT) combined with chemotherapy. Survival rates of patients who underwent upfront surgery for ICC were compared with those of patients who underwent surgery after downstaging therapy.

RESULTS

A total of 169 patients resected for ICC were included: 137 underwent upfront surgery and 32 received downstaging treatment because their tumor was initially unresectable (13 received chemotherapy, 19 received SIRT). Median OS was not different between the two groups: 32.3 months [95% confidence interval (CI) 23.9-40.7] with primary surgery versus 45.9 months (95% CI 32.3-59.4) with downstaging treatment (p = 0.54, log-rank test). In a multivariable Cox regression model, downstaging treatment was not associated with a better or worse prognosis; however, delivery of SIRT as a downstaging treatment was associated with a significant benefit in multivariable analysis (hazard ratio 0.34, 95% CI 0.14-0.84; p = 0.019).

CONCLUSIONS

Overall survival of patients resected after downstaging treatment was not different compared with the OS of patients resected upfront. Patients should therefore again be discussed with the surgeon following medical treatment. SIRT may be an efficient neoadjuvant therapy in patients with resectable ICC, in order to improve surgical results.

OS7.7 Educational program for caregivers of patients with brain tumors: AGAPE

BACKGROUND

Patients with brain tumors suffer from physical, neurocognitive, and psychological decline. Among the potential evolutions of the disease, patients become dependent on caregivers. Nearly half suffer from anxiety or depression, which can significatively impact their quality of life. Better medical information and more effective integration of the caregivers are positively received. Patients and caregivers need more information on supportive care and the specificities of brain tumors. Educational programs may help them better support this new caregiving role and give them more information on the disease.

MATERIALS AND METHODS

At the Comprehensive Cancer Centre in Rennes, we have created an educational program for caregivers of patients with brain tumor, called AGAPE. The aim of AGAPE is to explain more precisely the medical aspects of brain tumors, describe resources that are available to caregivers, and allow a moment of exchange between caregivers. A medical oncologist and a nurse specialized in neuro-oncology organize the program divided into three workshops. During the first workshop, neurocognitive symptoms that may be presented by the patients as well as therapeutics are discussed. The second workshop aims to provide information on instrumental and human resources available, as well as on psychometrics, nutrition, and palliative care units. The last workshop gives each caregiver the opportunity to share their difficulties. In order to objectively evaluate the impact of AGAPE, caregivers are asked to complete a quality of life questionnaire after each workshop: CargoQoL (Caregiver Oncology Quality of Life). We retrospectively analyzed CargoQoL scores for each caregiver during their participation in AGAPE in order to evaluate the impact of AGAPE on the caregiver’s quality of life.

RESULTS

From February 2015 to February 2018, 9 three-month sessions were organized, allowing 45 caregivers to participate. Data for the years 2018 and 2019 are currently being updated. Each group of 3 to 4 caregivers met once a month for a period of 3 months. Final analysis of CargoQoL was based on 21 caregivers (responses with excessive missing data and the experience of caregivers who assisted to only one of the workshops organized every 3 months were not taken into account). For the 9 items of CargoQoL, there was no decrease in quality of life between the first and the last workshop. Even though these findings are not significant, caregivers seem to have a better relationship with healthcare providers and better self-esteem after attending the AGAPE workshops.

CONCLUSION

Diagnosis of brain tumors impacts the quality of life of both patients and caregivers. The assessment of the caregivers’ needs is essential in order to support them in caring for their loved ones and to include them in the healthcare process. AGAPE educational programs help caregivers maintain their quality of life.

Dual IRE1 RNase functions dictate glioblastoma development

Proteostasis imbalance is emerging as a major hallmark of cancer, driving tumor aggressiveness. Evidence suggests that the endoplasmic reticulum (ER), a major site for protein folding and quality control, plays a critical role in cancer development. This concept is valid in glioblastoma multiform (GBM), the most lethal primary brain cancer with no effective treatment. We previously demonstrated that the ER stress sensor IRE1α (referred to as IRE1) contributes to GBM progression, through XBP1 mRNA splicing and regulated IRE1-dependent decay (RIDD) of RNA Here, we first demonstrated IRE1 signaling significance to human GBM and defined specific IRE1-dependent gene expression signatures that were confronted to human GBM transcriptomes. This approach allowed us to demonstrate the antagonistic roles of XBP1 mRNA splicing and RIDD on tumor outcomes, mainly through selective remodeling of the tumor stroma. This study provides the first demonstration of a dual role of IRE1 downstream signaling in cancer and opens a new therapeutic window to abrogate tumor progression.