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Selective internal radiation therapy using yttrium-90 microspheres for treatment of localized and locally advanced intrahepatic cholangiocarcinoma

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

 Abstract

Objectives

To evaluate safety and effectiveness of selective internal radiation therapy (SIRT) using yttrium-90 for localized and locally advanced intrahepatic cholangiocarcinoma (iCCA).

Methods

A retrospective review was performed of patients with localized iCCA treated with SIRT at a single institution. Overall survival (OS), local tumor response, progression-free survival (PFS), and toxicity were collected. Stratified analysis was performed based on surgical resection. Predictor analysis of OS was performed using the Fine-Grey regression analysis model with patients bridged to surgery regarded as competing events.

Results

A total of 28 consecutive patients with localized iCCA were treated with a total of 38 sessions of SIRT (17 segmental, 13 lobar, and 8 combined deliveries) and a mean dominant target dose per session of 238.4 ± 130.0 Gy. The cumulative radiologic response rate was 16/28 (57.1%) with a median PFS of 265 days. Median survival time (MST) was 22.9 months for the entire cohort with 1-year and 3-year survival of 78.4% and 45.1%, respectively. Ten patients (34.5%) were downstaged to surgical intervention (7 resection, 3 transplant) and showed longer OS (p = 0.027). The 1-year and 3-year OS for patients who received surgery were 100% and 62.5% (95% CI: 14.2–89.3%), respectively. Age (p = 0.028), Eastern Cooperative Oncology Group performance status (p = 0.030), and objective radiologic response (p=0.014) are associated with OS. Two ≥grade 3 hyperbilirubinemia, anemia, and one pleuro-biliary fistula occurred post-SIRT.

Conclusions

SIRT for localized iCCA is safe and effective in achieving radiological response, downstaging to surgery and transplant, and resulting in pathologic necrosis.

Clinical relevance statement

Selective internal radiation therapy should be considered for patients with localized and locally advanced intrahepatic cholangiocarcinoma.

Key Points

• The effectiveness of radioembolization for intrahepatic cholangiocarcinoma (iCCA) can be underestimated given the inclusion of extrahepatic disease.

• Radioembolization is safe and effective for local and locally advanced iCCA. Age, Eastern Cooperative Oncology Group performance status, and radiologic response are associated with survival.

• Radioembolization should be considered for patients with localized and locally advanced iCCA.

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Abbreviations

ALP:

Alkaline phosphatase

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

CA 19-9:

Carbohydrate antigen 19-9

CEA:

Carcinoembryonic antigen

CI:

Confidence interval

CR:

Complete response

CT:

Computed tomography

ECOG:

Eastern Cooperative Oncology Group

iCCA:

Intrahepatic cholangiocarcinoma

LDLT:

Living donor liver transplant

MISPHEC:

The Yttrium-90 Microspheres in Cholangiocarcinoma trial

mOS:

Median OS

MRI:

Magnetic resonance imaging

MST:

Median survival time

NLR:

Neutrophil/lymphocyte ratio

ORR:

Objective response rate

OS:

Overall survival

PD:

Progressive disease

PR:

Partial response

RECIST:

Response Evaluation Criteria in Solid Tumors

SD:

Stable disease

SHR:

Subdistribution hazard ratio

SIRT:

Selective internal radiation therapy

Y90:

Yttrium-90

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Authors and Affiliations

  1. Vascular and Interventional Radiology, Department of Radiology, Medical Center, University of Chicago, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA

    Qian Yu, Ethan Ungchusri, Thuong Van Ha & Osman Ahmed

  2. Division of Gastroenterology, Hepatology, and Nutrition, Medical Center, University of Chicago, University of Chicago, Chicago, IL, 60637, USA

    Anjana Pillai

  3. Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, 60637, USA

    Chih-Yi Liao

  4. Liver Tumor Center, University of Chicago Medicine, Chicago, IL, 60637, USA

    Talia Baker, John Fung & Diego DiSabato

  5. Department of Pathology, University of Chicago Medicine, Chicago, IL, 60637, USA

    Mengxue Zhang

  6. Department of Public Health Sciences, University of Chicago, Chicago, IL, 60637, USA

    Chuanhong Liao

Authors
  1. Qian Yu
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Correspondence to Qian Yu.

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The scientific guarantor of this publication is Qian Yu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

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Written informed consent was waived by the Institutional Review Board.

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• Retrospective

• Observational study

• Performed at one institution

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Yu, Q., Ungchusri, E., Pillai, A. et al. Selective internal radiation therapy using yttrium-90 microspheres for treatment of localized and locally advanced intrahepatic cholangiocarcinoma. Eur Radiol 34, 2374–2383 (2024). https://doi.org/10.1007/s00330-023-10203-3

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