1. Yttrium-90 Radioembolization of Unresectable Intrahepatic Cholangiocarcinoma: Long-Term Follow-up for a 136-Patient Cohort.
- Author
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Gupta AN, Gordon AC, Gabr A, Kalyan A, Kircher SM, Mahalingam D, Mulcahy MF, Merkow RP, Yang AD, Bentrem DJ, Caicedo-Ramirez JC, Riaz A, Thornburg B, Desai K, Sato KT, Hohlastos ES, Kulik L, Benson AB, Salem R, and Lewandowski RJ
- Subjects
- Bile Ducts, Intrahepatic pathology, Cohort Studies, Follow-Up Studies, Humans, Retrospective Studies, Treatment Outcome, Yttrium Radioisotopes therapeutic use, Bile Duct Neoplasms pathology, Cholangiocarcinoma surgery, Embolization, Therapeutic, Liver Neoplasms therapy
- 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., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)
- Published
- 2022
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