Yttrium-90 Transarterial Radioembolization for Chemotherapy-Refractory Intrahepatic Cholangiocarcinoma: A Prospective, Observational Study

J Vasc Interv Radiol. 2019 Aug;30(8):1185-1192. doi: 10.1016/j.jvir.2019.03.018. Epub 2019 Jun 27.

Abstract

Purpose: To evaluate the safety and efficacy of yttrium-90 transarterial radioembolization (TARE) for the treatment of unresectable, chemotherapy-refractory intrahepatic cholangiocarcinoma (ICC).

Methods: A prospective, observational study was carried out in 10 centers between 2013 and 2017. TARE plus standard care was delivered to patients with unresectable, chemotherapy-refractory or chemotherapy-intolerant ICC. Primary outcome was overall survival. Secondary outcomes included safety, progression-free survival (PFS), and liver-specific progression-free survival (LPFS).

Results: Sixty-one patients were treated with TARE. Patients were 53% male; median age was 64 years; 91% had performance status 0/1; 92% had received prior chemotherapy; and 59% had no extrahepatic disease. Median follow-up was 13.9 months (95% confidence interval [CI], 9.6-18.1). Overall survival was 8.7 months (95% CI, 5.3-12.1), and 37% of patients survived to 12 months. PFS was 2.8 months (95% CI, 2.6-3.1), and LPFS was 3.1 months (95% CI, 1.3-4.8). One severe complication (abdominal pain) occurred at the time of the TARE procedure. Thirty patients experienced a total of 49 adverse events, of which 8% were grade ≥3; most common were grade 1-2 fatigue and abdominal pain. A total of 77 abnormal laboratory value events were recorded, of which 4% were grade ≥3.

Conclusions: Patients with advanced ICC have limited therapeutic options and a poor prognosis. This prospective study examined the survival of patients with unresectable, chemotherapy-refractory primary ICC treated with TARE in real-world practice. The results demonstrate that this treatment merits further investigation in this patient cohort in a larger study, including collection of patient-reported outcomes.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Bile Duct Neoplasms / diagnostic imaging
  • Bile Duct Neoplasms / mortality
  • Bile Duct Neoplasms / pathology
  • Bile Duct Neoplasms / radiotherapy*
  • Cholangiocarcinoma / diagnostic imaging
  • Cholangiocarcinoma / mortality
  • Cholangiocarcinoma / pathology
  • Cholangiocarcinoma / radiotherapy*
  • Disease Progression
  • Drug Resistance, Neoplasm*
  • Embolization, Therapeutic / adverse effects
  • Embolization, Therapeutic / methods*
  • Embolization, Therapeutic / mortality
  • England
  • Female
  • Humans
  • Male
  • Middle Aged
  • Progression-Free Survival
  • Prospective Studies
  • Radiopharmaceuticals / administration & dosage*
  • Radiopharmaceuticals / adverse effects
  • Risk Factors
  • Time Factors
  • Yttrium Radioisotopes / administration & dosage*
  • Yttrium Radioisotopes / adverse effects

Substances

  • Radiopharmaceuticals
  • Yttrium Radioisotopes