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Transarterial Hepatic Yttrium-90 Radioembolization in Patients with Unresectable Intrahepatic Cholangiocarcinoma: Factors Associated with Prolonged Survival

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Abstract

Introduction

In unresectable intrahepatic cholangiocarcinoma (ICC), systemic chemotherapy often is viewed as the only option, although efficacy is limited. Radioembolization (RE) using yttrium-90 (90Y) microspheres is an accepted therapy for patients with hepatocellular-carcinoma or metastatic liver tumors. However, there are limited data on the value of RE in patients with ICC and few data on factors influencing prognosis. The purpose of our retrospective analysis was to establish which factors influenced time-to-progression (TTP) and overall survival (OS).

Methods

Patients with unresectable ICC were treated with 90Y resin-microspheres and assessed at 3-monthly intervals. Radiologic response was evaluated by using Response Criteria in Solid Tumors (RECIST). Baseline characteristics, biochemical/clinical toxicities, and response were examined for impact on TTP and OS.

Results

Thirty-four treatments were administered to 33 patients without major complications. By RECIST, 12 patients had a partial response, 17 had stable disease, and 5 had progressive disease after 3 months. The median OS was 22 months posttreatment and 43.7 months postdiagnosis. Median TTP was 9.8 months. Survival and TTP were significantly prolonged in patients with ECOG 0 (vs. ECOG 1 or 2; median OS: 29.4, 10, and 5.1 months; TTP: 17.5, 6.9, and 2.4 months), tumor burden ≤25% (OS: 26.7 vs. 6 months; TTP: 17.5 vs. 2.3 months), or tumor response (PR or SD vs. PD; OS: 35.5, 17.7 vs. 5.7 months; TTP: 31.9, 9.8 vs. 2.5 months), respectively (P < 0.001).

Conclusions

Radioembolization is an effective and safe option for patients with unresectable ICC. Predictors for prolonged survival are performance status, tumor burden, and RECIST response.

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Authors and Affiliations

  1. Institute of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany

    Ralf-T. Hoffmann, Philipp M. Paprottka, Fabian Bamberg, Christoph T. Trumm, Tobias F. Jakobs & Maximilian F. Reiser

  2. Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich, Germany

    Alexander Haug

  3. Department of Medicine II, Ludwig-Maximilians-University, Munich, Germany

    Agnes Schön, Eva-Maria Dürr, Barbara Rauch & Frank T. Kolligs

  4. Department of Radiology, Interventional Radiology and Nuclear Medicine, Klinikum Bogenhausen, Munich, Germany

    Thomas K. Helmberger

  5. Institute of Clinical Radiology, University of Munich – Campus Grosshadern, Marchioninistrasse 15, Munich, Germany

    Ralf-T. Hoffmann & Philipp M. Paprottka

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  1. Ralf-T. Hoffmann
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  2. Philipp M. Paprottka
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Corresponding authors

Correspondence to Ralf-T. Hoffmann or Philipp M. Paprottka.

Additional information

R.-T. Hoffmann and P.M. Paprottka contributed equally to this article.

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Hoffmann, RT., Paprottka, P.M., Schön, A. et al. Transarterial Hepatic Yttrium-90 Radioembolization in Patients with Unresectable Intrahepatic Cholangiocarcinoma: Factors Associated with Prolonged Survival. Cardiovasc Intervent Radiol 35, 105–116 (2012). https://doi.org/10.1007/s00270-011-0142-x

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  • DOI: https://doi.org/10.1007/s00270-011-0142-x

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