Prognostic Factors in Overall Survival of Patients with Unresectable Intrahepatic Cholangiocarcinoma Treated by Means of Yttrium-90 Radioembolization: Results in Therapy-Naïve Patients

Abstract

Tumor burden represents a key prognostic factor of survival in therapy-naïve patients with unresectable ICC treated with Y-90 RE therapy only.

Prognostic Factors for Overall Survival in Advanced Intrahepatic Cholangiocarcinoma Treated with Yttrium-90 Radioembolization

“…Radioembolization has been proposed as a potential alternative for irresectable ICC, particularly because TARE especially in hypovascular liver tumors is considered more suitable than other transarterial embolization therapies, as the chemotherapeutic agents might not adequately reach the target in poorly perfused lesions [3,22]. Several studies have reported a potential benefit for TARE in ICC, but most confer to patients with limited disease or naïve to other anticancer treatments [3,12]; in some, TARE was able to even achieve a disease reduction allowing for subsequent surgical resection [14]. A recent pooled analysis of 90 Y TARE in unresectable ICC summarizing 12 cohort studies revealed a median survival of 14.3 months, similarly indicating that most TARE studies included patients with a limited disease extent [23].…”

“…To date, there is no evidence that the choice of glass versus resin microspheres has a significant impact on tumor response or survival [3,10,11,22]. However, Levillain et al showed that the efficacy of TARE in unresectable ICC significantly depends on the delivered tumor radiation dose.…”

“…The reported incidence has increased worldwide over the past few decades [1]. Mortality from ICC is increasing in the US and UK and has tripled in Germany from 1998 to 2008 [2,3]. The five-year survival is below 5%, even for those patients who undergo tumor resection.…”

“…Since the first reports, 90 Y radioembolization has been shown to be an effective method for both primary liver cancer, especially HCC, as well as secondary liver cancer, with the most existing evidence in metastatic colorectal cancer [8,9]. There is an increasing number of reports on the use of 90 Y radioembolization for intrahepatic cholangiocarcinoma, but the evidence of resin-based 90 Y microspheres in the treatment of unresectable and chemorefractory ICC is still limited [3,[10][11][12][13][14]. First results suggest that the median overall survival treating ICC with 90 Y radioembolization is 13.9 months (9.5-18.3 months), thus being at least as high compared to systemic chemotherapy, but potentially reduced side effects [3].…”

“…There is an increasing number of reports on the use of 90 Y radioembolization for intrahepatic cholangiocarcinoma, but the evidence of resin-based 90 Y microspheres in the treatment of unresectable and chemorefractory ICC is still limited [3,[10][11][12][13][14]. First results suggest that the median overall survival treating ICC with 90 Y radioembolization is 13.9 months (9.5-18.3 months), thus being at least as high compared to systemic chemotherapy, but potentially reduced side effects [3]. Most reported results confer to therapy-naïve patients when TARE is a first line therapy.…”