Yttrium-90 Radioembolization for Unresectable Combined Hepatocellular-Cholangiocarcinoma
Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare mixed cell type primary liver cancer with limited data to guide management. Transarterial radioembolization with yttrium-90 microspheres (RE) is an emerging treatment option for both hepatocellular carcinoma and intrahepatic cholangiocarcinoma. This study explored the safety and efficacy of RE for unresectable cHCC-CC.
Patients with histopathologically confirmed cHCC-CC treated with RE were retrospectively evaluated. Clinical and biochemical toxicities were assessed using the Common Toxicity Criteria for Adverse Events v4.03. Radiological response was analyzed using the Response Criteria in Solid Tumors (RECIST) v1.1 and modified RECIST criteria. Survival times were calculated and prognostic variables identified.
Ten patients (median age 59 years; six men, four women) with unresectable cHCC-CC underwent 14 RE treatments with resin (n = 6 patients) or glass (n = 4 patients) microspheres. Clinical toxicities were limited to grade 1–2 fatigue, anorexia, nausea, or abdominal pain. No significant biochemical toxicities were observed. Median overall survivals from the first RE treatment and from initial diagnosis were 10.2 and 17.7 months, respectively. Six of seven patients with elevated tumor biomarker levels before RE showed decreased levels after treatment (median decrease of 72%, range 13–80%). Best hepatic radiological response was 60% partial response and 40% stable disease by modified RECIST, and 100% stable disease by RECIST v1.1. Poor performance status and the presence of macrovascular invasion were identified as predictors of reduced survival after RE.
RE appears to be a safe and promising treatment option for patients with unresectable cHCC-CC.
Level of Evidence
KeywordsRadioembolization Yttrium-90 microspheres Combined hepatocellular-cholangiocarcinoma Cholangiohepatoma Efficacy Safety
The authors are grateful to Jarrett Rosenberg, Ph.D., for assistance in statistical analyses.
No financial support was provided for this study.
Compliance with Ethical Standards
Conflict of interest
D. Sze is on the medical or scientific advisory boards for Boston Scientific, Inc., Koli Medical, Inc., RadiAction Medical, Inc.; is a consultant for Amgen, Inc., BTG International, Inc., EmbolX, Inc., W.L. Gore & Associates, Inc., and Viralytics, Inc.; receives institutional research support from Merit Medical, Inc., and W. L. Gore, Inc.; and owns equity interest in Confluent Medical, Inc., and Proteus Digital Health, Inc. J. Louie is a consultant for BTG International, Inc. The other authors declare no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective study, formal consent to participate in this study was not required.
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