Y90 Radioembolization Shows Promise for Treating Combined Hepatocellular-Cholangiocarcinoma

Transarterial radioembolization with yttrium-90 (Y90) microspheres shows promise as a safe, effective treatment for patients with unresectable combined hepatocellular-cholangiocarcinoma (cHCC-CC), a rare and aggressive form of primary liver cancer.  Researchers chose to investigate transarterial radioembolization with Y90 as a treatment option for cHCC-CC because of the therapy’s emerging use in both hepatocellular carcinoma and intrahepatic cholangiocarcinoma.

In this retrospective study, researchers analyzed data from 10 patients with histopathologically confirmed unresectable cHCC-CC treated with transarterial radioembolization with Y90 microspheres. Collectively, the patients underwent 14 procedures.

The study assessed clinical and biochemical toxicities, radiological response, survival times, and prognostic variables. Results revealed no significant biochemical toxicities and minimal clinical toxicities that consisted of grade 1-2 fatigue, anorexia, nausea, or abdominal pain. Patients survived for a median of 10.2 months after their first transarterial radioembolization with Y90 treatment. Median survival after initial diagnosis of cHCC-CC was 17.7 months.

Prior to treatment, 6 of 7 patients had elevated tumor biomarkers, which decreased after treatment. The median decrease in tumor biomarker levels following treatment was 72%, with a range of 13% to 80%.

According to modified Response Criteria in Solid Tumors (RECIST) criteria, the best radiological response was a 60% partial response (6 patients) and 40% stable disease (4 patients). Using RECIST v1.1, all patients showed stable disease.

Two factors—poor performance status and the presence of macrovascular invasion—predicted reduced survival after treatment.

Although the study was limited by its small sample size and retrospective design, the authors believe the results indicate that transarterial radioembolization with Y90 (RE) could safely and effectively treat unresectable cHCC-CC in a palliative setting. The hybrid nature of cHCC-CC tumors may be a factor in treatment success. “Among transarterial therapies, RE may provide distinctive advantages for treatment of this hybrid tumor since RE has shown favorable outcomes for treatment of both iCC and HCC, and therapeutic response may not be as dependent on tumor hypervascularity as with TACE,” the investigators wrote. However, although more research is needed, the rarity of cHCC-CC and the propensity for misdiagnosis may make future research challenging.

Reference

Chan LS, Sze DY, Poultsides GA, Louie JD, Abdelrazek Mohammed MA, Wang DS. Yttrium-90 Radioembolization for Unresectable Combined Hepatocellular-Cholangiocarcinoma. Cardiovasc Intervent Radiol. 2017;40(9):1383-1391.