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

Aakash N. Gupta, Andrew C. Gordon, Ahmed Gabr, Aparna Kalyan, Sheetal M. Kircher, Devalingam Mahalingam, Mary F. Mulcahy, Ryan P. Merkow, Anthony D. Yang, David J. Bentrem, Juan C. Caicedo-Ramirez, Ahsun Riaz, Bartley Thornburg, Kush Desai, Kent T. Sato, Elias S. Hohlastos, Laura Kulik, Al B. Benson, Riad Salem, Robert J. Lewandowski

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)1117-1128
Number of pages12
JournalCardiovascular and Interventional Radiology
Volume45
Issue number8
DOIs
StatePublished - Aug 2022
Externally publishedYes

Keywords

  • Intrahepatic cholangiocarcinoma
  • Radioembolization
  • Yttrium-90

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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