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.
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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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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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DOI: https://doi.org/10.1007/s00270-022-03183-2