Radioembolization Is Safe and Efficacious for Treatment of Unresectable Intrahepatic Cholangiocarcinoma
Patients with unresectable intrahepatic cholangiocarcinoma (ICC) can benefit from transarterial ytrrium-90 (Y-90) glass microsphere radioembolization, according to a study published in the Journal of Vascular and Interventional Radiology.
ICC frequently is asymptomatic, and, as a result, many patients have unresectable, advanced tumors by the time they present for medical treatment. Transarterial radioembolization with Y-90 has been included as a treatment option for such patients, but previously reported studies have only evaluated a small number of patients and have had widely varying survival outcomes.
The current study retrospectively reviews medical records of 85 consecutive patients with biopsy-proven ICC. The patients (41 men and 44 women) underwent radioembolization at a single institution between May 2009 and May 2016. The Kaplan-Meier method, Cox regression models, and the log-rank tests were used to evaluate survival data.
Results showed that patients had a median overall survival of 21.4 months from diagnosis and a median overall survival of 12.0 months after radioembolization. The researchers also noted that there were 7 instances of severe toxicity among the patient group. When imaging was conducted 3 months post radioembolization, 6.2% of patients were found to have a partial response, while 64.2% had stable disease and 29.6% had progressive disease.
There was a significantly long ermedian overall survival after radioembolization in patients with Eastern Cooperative Oncology Group (ECOG) scores of 0 and 1 than patients with an ECOG score of 2 (18.5 vs 5.5 months). Additionally, patients with well-differentiated histology had an 18.5 month median overall survival versus a 9.7 month median overall survival in patients with poorly differentiated histology.
Patients with absence of extrahepatic metastasis had significantly increased overall median survival compared to those who did have extrahepatic metastasis (15.2 vs. 6.8 months). Overall survival was likely to be shorter in patients who had a greater time from diagnosis to radioembolization. Decreased overall survival was predicted by post-treatment increased cancer antigen 19-9 level, increased international normalized ratio, decreased albumin, increased bilirubin, increased aspartate aminotransferase, and increased Model for End-Stage Liver Disease score. Some factors, such as the morphology of the tumor, did not effect survival.
“These data support the therapeutic role of radioembolization for the treatment of unresectable ICC with good efficacy and an acceptable safety profile,” the researchers concluded.
Gangi A, Shah H, Hatfield N, et al. intrahepatic cholangiocarcinoma treated with transarterial yttrium-90 glass microsphere radioembolization: results of a single institution retrospective study. J Vasc Interv Radiol. 3 July 2018. Online ahead of print. doi: https://doi.org/10.1016/j.jvir.2018.04.001.