The Insider summarizes important, recent and pertinent publications to the SIO community.
Annals of Surgical Oncology (06/03/22) RCG Martin; KA Simo; P Hansen; et al.
For patients with unresectable intrahepatic cholangiocarcinoma (ICC), the combination of gemcitabine and cisplatin (Gem/Cis) with irinotecan drug-eluting beads (DEBIRI) therapy by transarterial infusion is safe and results in substantial improvements in downsizing to resection, longer progression-free survival, and overall survival, according to new research. The prospective, open-label Phase II study included 48 patients in the intent-to-treat population. In all, 24 patients were randomized to treatment with Gem/Cis and DEBIRI and 22 were randomized to Gem/Cis alone (with 2 screen failures). Liver involvement and the presence of extrahepatic disease were similar in the two groups, at 35% vs. 38% and 29% vs. 14% (p=0.12), respectively. The median number of chemotherapy cycles in each group was 6, while the rates of grade 3/4 adverse events were 34% and 36%, respectively. The overall response rate — the primary endpoint — was much higher in the Gem/Cis-DEBIRI group compared with the Gem/Cis group at 2 (p<0.04), 4 (p<0.03), and 6 months (p<0.05). With rates of 25% vs. 8%, there was much more downsizing to resection/ablation in the Gem/Cis-DEBIRI group compared with Gem/Cis alone. Median progression-free survival and overall survival were significantly higher with Gem/Cis-DEBIRI at 31.9 months vs. 10.1 months and 33.7 months vs. 12.6 months, respectively. Annals of Surgical Oncology (06/03/22) RCG Martin; KA Simo; P Hansen; et al.
CardioVascular and Interventional Radiology (04/11/22) T Ouyang; Y Cao; C Zheng
A retrospective study demonstrated the safety of transarterial chemoembolization (TACE) with radiofrequency ablation (RFA) plus apatinib for the treatment of intermediate or advanced hepatocellular carcinoma (HCC). The three-modality treatment had better efficacy compared with TACE plus apatinib or TACE alone. The study included 175 patients: 24 who received TACE plus RFA and apatinib (TACE + RFA-A), 82 who received TACE plus apatinib (TACE-A), and 69 who only received TACE. The median time to progression (TTP) with TACE + RFA-A was 8.0 months, compared with 6.0 months for TACE-A and 3.0 months for TACE alone. The median overall survival (OS) in the three groups was 23.0 months, 18.0 months, and 8.0 months, respectively. Treatment strategy and tumor size were independent prognostic factors for OS and TTP, according to multivariate Cox analysis, while the Child-Pugh stage was a predictive factor for OS. There were no treatment-related deaths.
CardioVascular and Interventional Radiology (04/11/22) T Ouyang; Y Cao; C Zheng
Radiology (06/28/22) EC Emmons; S Bishay; L Du; et al.
In the RESIN Registry, patients with colorectal cancer metastases who underwent transarterial radioembolization (TARE) with resin yttrium 90 microspheres had a median overall survival (OS) of 15.0 months. The prospective multicenter observational registry treated adult patients with TARE using resin microspheres for liver-dominant metastatic colorectal cancer at 42 centers from 2015-2020. The study involved 498 participants (median age, 60 years; 60% men). TARE was used as a first-line therapy in 17% (74 of 442 participants), second-line therapy in 41% (180), and third-line therapy or beyond in 43% (188). The median OS for the entire group was 15.0 months, while the median OS by line of therapy was 13.9 months for first-line therapy, 17.4 months for second-line therapy, and 12.5 months for third-line therapy. Progression-free survival (PFS) for the whole group was 7.4 months, while the median PFS by line of therapy was 7.9 months, 10.0 months, and 5.9 months, respectively. Grade 3-4 hepatic toxicities attributable to TARE were 8.4% for bilirubin and 3.7% for albumin, with grade 3 and higher toxicities higher with third-line therapy for bilirubin and albumin.
Radiology (06/28/22) EC Emmons; S Bishay; L Du; et al.
Journal of Cardiothoracic Surgery (02/11/22) Y Li; F Yang; YY Huang; et al.
Researchers compared the safety and efficacy of ablation and sublobar resection (SR) for the treatment of stage I non-small-cell lung cancer (NSCLC). The meta-analysis identified 816 potentially relevant articles published through November 2020 in the Cochrane Library, Embase, and PubMed databases. Of the eight articles selected for the final meta-analysis, there were 679 patients treated by SR and 468 who underwent ablation. Overall, patients in the SR group had a much lower pooled local recurrence rate, at 5.0% vs. 25.4%; pooled distant recurrence rates were similar, at 25.7% vs. 23.1%, respectively. Pooled complication rates were also similar in both groups; however, the pooled hazard ratio for overall survival, progression-free survival, and cancer-specific survival all favored SR treatment, with better survival outcomes among patients in that group. The pooled duration of post-operative hospitalization was significantly shorter among patients who underwent ablation compared with those in the SR group, with a mean difference of 5.93. Based on their findings in the meta-analysis, the researchers concluded that "SR was associated with lower [local recurrence] rates and prolonged survival relative to ablation when used to treat stage I NSCLC patients."
Journal of Cardiothoracic Surgery (02/11/22) Y Li; F Yang; YY Huang; et al.
Journal of Vascular and Interventional Radiology (05/22) Y Bi; X Shi; W Zhang; et al.
A retrospective study characterized the safety, tolerability, and efficacy of chemoembolization using drug-eluting embolic (DEE) microspheres in individuals with recurrent and advanced head and neck cancer. The study included 32 patients (mean age, 57.2 years): 16 with recurrent and 16 with advanced head and neck cancer. Six months after the patients were treated with chemoembolization using DEE microspheres loaded with doxorubicin, the objective response rate was 25%, while the disease control rate was 69%. Median overall survival was 14.5 months, and local progression-free survival was 13.6 months. Twenty-two percent (7) of the patients experienced adverse events — all of which were related to postembolization syndrome — including localized pain, pyrexia, and vomiting and nausea. There were no severe adverse events or procedure-related deaths.
Journal of Vascular and Interventional Radiology (05/22) Y Bi; X Shi; W Zhang; et al.
Current Opinion in Biotechnology (10/01/20) Vol. 65, P. 60 C Yakkala; A Denys; L Kandalaft; et al.
A review articles discusses recent findings on the immunological aspects of cryoablation, immunotherapies that can be paired with cryoablation, and emerging evidence on the therapeutic benefits of cryo-immunotherapy. Use of the hypothermic modality, used to destroy cancer lesions, leaves the ablated tumor in situ, which enables various tumor antigens to be available to the host's immune system. Cryoablation can be used to strengthen the effect of immunotherapies, with checkpoint inhibitors, toll-like receptor agonists, adoptive cell therapies, and epigenetic modulators all demonstrating the ability to boost the immune system against tumors. The researchers recommend that "future endeavors should focus on tailoring cryo-immunotherapies based on the tumor's immune signature and testing alternative approaches to circumvent treatment-associated toxicities and maximize efficacy." Key factors to be addressed include the type of tumor to undergo cryoablation, the volume of ablation, and the frequency of ablations needed to produce a sustained immune response.
Current Opinion in Biotechnology (10/01/20) Vol. 65, P. 60 C Yakkala; A Denys; L Kandalaft; et al.
The Society of Interventional Oncology presents an opportunity to share key findings from interesting patient cases within the interventional oncology community. Access to these cases and engaging in the discussion surrounding their content is a benefit of SIO membership. New cases will be released in the SIO Insider.

July Case Spotlight - An Unconventional Approach to Chemoembolization
Crossword Puzzle
Introducing a fun, new feature in the newsletter — an IR-related crossword puzzle. This month's puzzle is titled "Greek & Latin" Click here for a printable version of the crossword puzzle. If you're stuck, the solution can be found below as well.

This newsletter is supported by an educational grant from Varian, A Siemens Healthineers Company
Publications Committee
Christos Georgiades, MD, PhD, FSIR, FCIRSE
SIO Publications Chair

AJ Gunn, MD
SIO Publications Vice Chair

Edward Kim, MD, FSIR
SIO Board Liaison
Yilun Koethe, MD, RPVI
Christine E. Boone, MD, PhD
Ji Buethe, MD
Andrew Kolarich, MD
Juan C. Camacho, MD
Anish Ghodadra, MD
Alex J. Solomon, MD
Elena Violari, MD
Maria Tsitskari, MD
Chiara Zini, MD
Giovanni Mauri, MD
This newsletter is brought to you by the Society of Interventional Oncology (SIO) and supported by an educational grant from Varian, A Siemens Healthineers Company. SIO's mission is to advance interventional oncology by developing evidence supporting IO therapies, educating IO practitioners, and improving patient access to IO therapies.

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