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Monday, August 3, 2020

Yttrium-90 Radioembolization in Intrahepatic Cholangiocarcinoma: A Multicenter Retrospective Analysis


Clinical question
What are the outcomes of treating unresectable intrahepatic cholangiocarcinoma with yttrium-90 radioembolization?

Take-away point
Y90 radioembolization is a safe treatment option for intrahepatic cholangiocarcinoma, however its role in treatment is unclear

Reference
Stefan Buettner et al. Yttrium-90 Radioembolization in Intrahepatic Cholangiocarcinoma: A Multicenter Retrospective Analysis. Journal of Vascular and Interventional Radiology. 2020: 31; 1035-1043.


Study design
Retrospective Review

Funding source
Self-funded or unfunded

Setting
Multi-Center





Summary

Despite being the second most common primary liver malignancy, intrahepatic cholangiocarcinoma (ICC) is unresectable in the vast majority of patients. Median survival is 3-8 months, and is improved to 11.7 months with gemcitabine and cisplatin. Smaller studies have demonstrated a survival benefit of radioembolization in ICC. This study provides a retrospective review of patients with ICC after radioembolization. Data from 6 centers over a 10 year 8 month period was reviewed. Both glass and resin microspheres treatments were included. 114 patients were included, 92 treated with resin and 22 treated with glass microspheres.

25% of patients had partial presence by RECIST criteria following glass microsphere treatment compared to 3% after resin microspheres. 62% of patients had disease progression following glass microsphere treatment compared to 76% after resin microspheres. Laboratory toxicity was seen in 45% of the glass microsphere cohort compared to 42% of the microsphere cohort. However, less than 10% had significant toxicity. Median overall survival after diagnosis was 22 months in the glass microsphere group and 30 months for the resin group. Median overall survival after treatment was 9 months for the glass microsphere group and 11 months for the resin group.


Commentary

RECIST response rate favored glass microspheres, however survival outcomes did not differ. A small percent, 4%, were able to be downstaged to resection. As with many interventional oncology studies, the heterogeneity of the patient population, notably prior and subsequent treatment, clouds evaluation of survival data. While radioembolization is clearly safe, its benefit compared to standard chemotherapy is unclear with post treatment survival being inferior to previously published data of survival after chemotherapy. RECIST data favored glass microsphere treatment over resin, this did not bare out on survival data.

Ongoing and future studies comparing yttrium-90 to comparative first line treatment will help elucidate the role of radioembolization in the treatment of ICC.

Post Author:
David M Mauro, MD
Assistant Professor
Department of Radiology, Vascular and Interventional Radiology
University of North Carolina

@DavidMauroMD

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