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Yttrium-90 Radioembolization of Unresectable Intrahepatic Cholangiocarcinoma: Long-Term Follow-up for a 136-Patient Cohort

CardioVascular and Interventional Radiology volume 45, pages 1117–1128 (2022)Cite this article

Abstract

Purpose

Unresectable intrahepatic cholangiocarcinoma (ICC) signifies a poor prognosis with limited treatment options beyond systemic chemotherapy. This study’s purpose was to evaluate the safety, efficacy, and potential for downstaging to resection of yttrium-90 (Y90) radioembolization for treatment of unresectable ICC.

Materials and Methods

From 2004 to 2020, 136 patients with unresectable ICC were treated with radioembolization at a single institution. Retrospective review was performed of a prospectively collected database. Outcomes were (1) biochemical and clinical toxicities, (2) local tumor response, (3) time to progression, and (4) overall survival (OS) after Y90. Univariate/multivariate survival analyses were performed. A subgroup analysis was performed to calculate post-resection recurrence and OS in patients downstaged to resection after Y90.

Results

Grade 3+ clinical and biochemical toxicities were 7.6% (n = 10) and 4.9% (n = 6), respectively. Best index lesion response was complete response in 2 (1.5%), partial response in 42 (32.1%), stable disease in 82 (62.6%), and progressive disease in 5 (3.8%) patients. Median OS was 14.2 months. Solitary tumor (P < 0.001), absence of vascular involvement (P = 0.009), and higher serum albumin (P < 0.001) were independently associated with improved OS. Eleven patients (8.1%) were downstaged to resection and 2 patients (1.5%) were bridged to transplant. R0-resection was achieved in 8/11 (72.7%). Post-resection median recurrence and OS were 26.3 months and 39.9 months, respectively.

Conclusion

Y90 has an acceptable safety profile and high local disease control rates for the treatment of unresectable ICC. Downstaging to resection with > 3 years survival supports the therapeutic role of Y90 for unresectable ICC.

Level of Evidence: Level 3, single-arm single-center cohort study.

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Abbreviations

CA:

Carbohydrate antigen

CT:

Computed tomography

ICC:

Intrahepatic cholangiocarcinoma

MR:

Magnetic resonance

OS:

Overall survival

TTP:

Time to progression

WHO:

World Health Organization

Y90:

Yttrium-90

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Acknowledgements

The authors thank Vanessa L. Gates, Karen Grace, Krystina Salzig, Melissa Williams, and Carlene del Castillo for their compassionate care of patients and dedication to clinical research.

Funding

This study was not supported by any funding.

Author information

Author notes

  1. Aakash N. Gupta

    Present address: Department of Radiology, Division of Interventional Radiology, Stanford University, Stanford, CA, 94305, USA

Authors and Affiliations

  1. Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, 676 N. St. Clair St., Suite 800, Chicago, IL, 60611-2908, USA

    Aakash N. Gupta, Andrew C. Gordon, Ahmed Gabr, Mary F. Mulcahy, Ahsun Riaz, Bartley Thornburg, Kush Desai, Kent T. Sato, Elias S. Hohlastos, Laura Kulik, Riad Salem & Robert J. Lewandowski

  2. Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago, IL, USA

    Aparna Kalyan, Sheetal M. Kircher, Devalingam Mahalingam, Mary F. Mulcahy, Al B. Benson, Riad Salem & Robert J. Lewandowski

  3. Department of Surgery, Division of Organ Transplantation, Northwestern University, Chicago, IL, USA

    Mary F. Mulcahy, Juan C. Caicedo-Ramirez, Laura Kulik, Riad Salem & Robert J. Lewandowski

  4. Department of Surgery, Division of Surgical Oncology, Northwestern University, Chicago, IL, USA

    Ryan P. Merkow, Anthony D. Yang & David J. Bentrem

  5. Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA

    David J. Bentrem

  6. Department of Surgery, Division of Vascular Surgery, Northwestern University, Chicago, IL, USA

    Kush Desai

  7. Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL, USA

    Laura Kulik

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  1. Aakash N. Gupta
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Corresponding author

Correspondence to Robert J. Lewandowski.

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Conflict of interest

A.C.G. consults for ABK Biomedical Inc. A.D.Y. receives support from the National Heart, Lung, and Blood Institute award K08HL145139. A.R. consults for Boston Scientific. L.K. is a speaker for Gilead Sciences and Eisai and an advisor for Roche, Genentech, and Exelixis. A.B.B. is a consultant/advisor for Merck Sharp & Dohme, Array BioPharma, Bristol-Myers Squibb, Samsung Bioepis, Pfizer, HalioDx, Abbvie, Janssen Oncology, Natera, Apexigen, Artemida, Xencor, and Therabionic and receives research funding from Infinity Pharmaceuticals, Merck Sharp & Dohme, Taiho Pharmaceutical, Bristol-Myers Squibb, Celgene, Rafael Pharmaceuticals, MedImmune, Xencor, Astellas Pharma, Amgen, Syncore, Elevar Therapeutics, Tyme Inc, ST Pharm, and ITM Solucin GmbH. R.S. consults for Boston Scientific, Astrazeneca, Genentech, Sirtex, Cook, Eisai, Bard, and QED Therapeutics. R.J.L. is an adviser and on speaker bureau for Boston Scientific, consultant for Bard, Varian, ABK Medical, Alhambra Medical, and receives research support from National Institutes of Health grant R01CA233878-01. All remaining authors have declared no conflicts of interest.

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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.

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Informed consent was obtained from all individual participants included in the study.

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Appendix

Appendix

See Fig. 

Fig. 4
figure 4

Flowchart diagram of patients included in the study

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4 and Tables 4,

Table 4 Systemic therapy prior to Y90
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Table 5 Yttrium-90 radioembolization dosimetry
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5,

Table 6 Systemic therapy after Y90
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6 and

Table 7 Outcomes for patients converted to resection
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7

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Gupta, A.N., Gordon, A.C., Gabr, A. et al. Yttrium-90 Radioembolization of Unresectable Intrahepatic Cholangiocarcinoma: Long-Term Follow-up for a 136-Patient Cohort. Cardiovasc Intervent Radiol 45, 1117–1128 (2022). https://doi.org/10.1007/s00270-022-03183-2

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Keywords

  • Intrahepatic cholangiocarcinoma
  • Radioembolization
  • Yttrium-90