Outcomes of Yttrium-90 Radioembolization for Unresectable Combined Biphenotypic Hepatocellular-Cholangiocarcinoma
What is the hepatic response and overall survival following Y-90 radioembolizations in patients with hepatocellular-cholangiocarcinoma (cHCC-CC)?
Y90 radioembolization is a potential treatment option for cHCC-CC as a well tolerated procedure and reasonable response rates.
Christopher D. Malone et al. Outcomes of Yttrium-90 Radioembolization for Unresectable Combined Biphenotypic Hepatocellular-Cholangiocarcinoma. Journal of Vascular and Interventional Radiology. May, 2020: 31; 5.
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Figure 2. Kaplan-Meier survival curves and univariate Cox proportional hazard models of factors predicting survival after radioembolization. (a, b) Having > 1 tumor (a) and bilobar disease (b) both protended a >3 times increase in hazard of survival after radioembolization. (c) Although not statistically significant, there was a strong trend toward increased hazard of survival in nonresponders to radioembolization after treatment. (d) CA 19-9 level > 101.3 before treatment, which was derived from Youden statistic, portended a > 4 times increased hazard of survival after radioembolzation.
This study evaluated 22 patients with biopsy confirmed cHCC-CC who underwent a total of 29 Y90 treatments utilizing resin microspheres. Overall survival and tumor response was analyzed. Median overall survival was 9.3 months following radioembolization. Complete response was seen in 15% with partial response in 40% of patients. The procedure was well tolerated with the majority of toxicities categorized as Grade 1 or 2. Poor prognostic indicators included bilobar disease, greater than one tumor, and elevated CA 19-9 levels.
This study is limited by factors that limit many Y90 trials including small patient size and variable previous and future treatment regimens. Future studies are needed to compare Y90 to TACE in this population to help guide treatment guidelines.
David M Mauro, MD
Department of Radiology, Vascular and Interventional Radiology
University of North Carolina