Safety and initial efficacy of ablative radioembolization for the treatment of unresectable intrahepatic cholangiocarcinoma

Abstract

Purpose: To investigate safety, response, and survival after ablative glass microsphere 90 Y radioembolization for unresectable intrahepatic cholangiocarcinoma. Materials and Methods: A retrospective review of 37 radioembolizations in 28 patients treated with single compartment dose of ≥190 Gy encompassing >75% of the largest tumor was performed. Tumors were assessed for stage, morphology, and arterial supply. Response per Modified Response Evaluation Criteria in Solid Tumors (mRECIST), freedom from progression (FFP), progression-free survival (PFS), overall survival (OS), biochemical hepatic function, performance status, and adverse events were investigated.Results: The median highest dose per patient was 256.8 Gy (195.7-807.8). Objective response at 3 months was 94.1% (complete 44.1% and partial 50%). Median OS was not reached and the 30-month OS rate was 59%, with a median follow-up of 13.4 months (5.4-39.4). FFP in the radiated field and overall FFP at 30 months were 67% and 40%, respectively. Favorable arterial supply was associated with improved OS (p = 0.018). Unfavorable arterial supply was associated with worse OS [HR 5.7 (95% CI 1.1-28.9, p = 0.034)], and PFS [HR 5.9 (95% CI 1.9-18.4, p = 0.002)]. Patients with mass-forming tumors had a survival benefit (p = 0.002).Laboratory values and performance status did not significantly change 3 months after radioembolization. Grade 3 and 4 adverse events occurred in 2 (7.1%) patients. Conclusions: Radioembolization of unresectable intrahepatic cholangiocarcinomawith ablative intent has a high response rate, promising survival, and is well tolerated.

Selective Internal Radiation Therapy with Yttrium-90 for Intrahepatic Cholangiocarcinoma: A Systematic Review on Post-Treatment Dosimetry and Concomitant Chemotherapy

“…In 2010, Saxena et al [ 60 ] reported that patients with mass-forming peripheral ICCs have a longer median survival duration than do patients with infiltrative lesions (18.3 months vs. 4.5 months). Similar results were also reported in a recent study by Paz-Fumagalli et al [ 26 ], indicating that patients with mass-forming tumors had a longer survival ( p = 0.002). Furthermore, as shown in several studies included in the present review, patient survival varies according to whether SIRT was used as a first-line treatment (for treatment-naïve ICC patients), for chemotherapy-refractory disease, or after the failure of other therapies [ 23 , 28 , 31 , 35 , 51 ].…”

“…After implementing our exclusion criteria, 47 papers were eligible for data extraction. Of the final 47 included papers, 40 were journal articles [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ] ( Table 1 ), and seven were conference abstracts [ 62 , 63 , 64 , 65 , 66 , 67 , 68 ] ( Table 2 ).…”

“…Eleven studies described the use of imaging to assess the distribution of 90 Y microparticles in the liver after SIRT. Of these, seven used Bremsstrahlung 90 Y SPECT-CT [ 23 , 24 , 26 , 28 , 41 , 46 , 49 ], and four used 90 Y positron emission tomography (PET)-CT [ 31 , 32 , 42 , 45 ] to confirm the distribution of 90 Y microspheres in the lesions and exclude extrahepatic deposition. True dosimetry verification studies were performed in only four studies ( Table 4 ) [ 22 , 25 , 27 , 43 ].…”

“…The studies’ varied response rates possibly stem from differences in their patient populations and a lack of standardized tumor dosimetry. Moreover, several issues should be taken into consideration when interpreting the results of the survival analysis following radioembolization, including the type of ICC, staging [ 26 ], and pathological grading [ 45 ]. In 2010, Saxena et al [ 60 ] reported that patients with mass-forming peripheral ICCs have a longer median survival duration than do patients with infiltrative lesions (18.3 months vs. 4.5 months).…”

The Evaluation of Clinical Status of Endoscopic Retrograde Cholangiography for the Placement of Metal and Plastic Stents in Cholangiocarcinoma Therapy

“…Patients have no special clinical symptoms in the early stage of the disease. With the prolongation of the disease time, the patients will have clinical symptoms such as fever, abdominal pain, fatigue, jaundice, and loss of appetite [ 1 ]. At present, cholangiocarcinoma is mainly treated by nutritional support, surgery, radiotherapy and chemotherapy, and interventional therapy [ 2 ].…”