Yttrium-90 Radioembolization Therapy for Combined Hepatocellular and Cholangiocarcinoma

Abstract

To report outcomes of transarterial radioembolization (TARE) using glass microspheres for the treatment of mixed hepatocellular-cholangiocarcinoma (HCC-CC) in a propensity-matched study. Material and Methods: Between 2013 and 2019, 10 consecutive patients with histologically confirmed HCC-CC received TARE of a targeted territory using glass microspheres as a primary initial treatment. Baseline demographics in addition to tumor distribution, Child Pugh score, and BCLC were recorded. Tumor response was assessed according to modified RECIST criteria. The HCC-CC cohort was matched to the HCC cohort, and objective response and survival analysis was performed. Results: In the HCC-CC cohort, patients had a 70% objective response rate (ORR), and in the HCC cohort, patients had a 90% ORR after matching (p = 0.54). The median overall survival (OS) for HCC patients was 12.3 months (95% CI: 6.0-17.4 months) in the matched population, and for HCC-CC patients, the median OS was 15.2 months (95% CI: 2.7-20.2 months) (p = 0.98). The median progression-free survival (PFS) for HCC patients was 11.6 months (95% CI: 2.53-19.3 months) in the matched population, and for HCC-CC patients, the median PFS was 15.2 months (95% CI: 2.7-20.2 months) (p = 0.94). The median transplant-free survival (TFS) for HCC patients was 12.3 months (95% CI: 6.0-17.4 months) in the matched population, and for HCC-CC patients, the median TFS was 15.2 months (95% CI: 2.7-20.2 months) (p = 0.98). Conclusions: While outcomes of combined HCC-CC are poor and optimal treatment remains undefined, TARE appears to represent an effective locoregional treatment with survival outcomes similar to that of HCC treated by TARE.

An international multicentre evaluation of treatment strategies for combined hepatocellular-cholangiocarcinoma✰

“…The studies looked at the effect of transarterial radioembolisation (TARE) with yttrium-90 in heterogeneous groups of patients with cHCC-CCA, ranging between 10 and 22 patients, and demonstrated median survival rates that lie between 9.3 and 15.2 months. [37] , [38] , [39] Although the radiological response rate after TARE varies widely with a complete response of 0–60%, a partial response of 10–60%, stable disease of 0–40%, and disease progression of 0–50%, the disease control rate shows a potential beneficial effect ranging between 50 and 100%. [36] , [37] , [38] , [39] Translated into PFS, lying between 5.2 and 16.6 months on the median.…”

“… [37] , [38] , [39] Although the radiological response rate after TARE varies widely with a complete response of 0–60%, a partial response of 10–60%, stable disease of 0–40%, and disease progression of 0–50%, the disease control rate shows a potential beneficial effect ranging between 50 and 100%. [36] , [37] , [38] , [39] Translated into PFS, lying between 5.2 and 16.6 months on the median. 37 , 39 …”

Primary Combined Hepatocellular-Cholangiocarcinoma: A Case of Underdiagnosed Primary Liver Cancer

“…The use of TARE has been minimally studied in the treatment of inoperable CHC. According to a study by Badar et al, a retrospective analysis involving 10 patients with CHC between 2013-2019 receiving TARE therapy, the median overall survival rate was 15.2 months [13]. Moreover, a similar study by Fowler et al examined six patients with CHC who underwent TARE, and they had a median overall survival rate of 16 months [14].…”

Hepatocellular-Cholangiocarcinoma Collision Tumors: An Update of Current Management Practices

“…Recently, Y90 has demonstrated comparable survival outcomes in cHCC-CC juxtaposed to HCC. 33 Badar et al discerned a 70% response rate versus a 90% response rate for cHCC-CC and HCC, respectively. 33 Additionally, it is proposed that TARE with Y90 can be used as a potential bridging therapy for cHCC-CC neoplasms.…”

“…33 Badar et al discerned a 70% response rate versus a 90% response rate for cHCC-CC and HCC, respectively. 33 Additionally, it is proposed that TARE with Y90 can be used as a potential bridging therapy for cHCC-CC neoplasms. Malone et al report a 9.3-month overall survival rate following Y90 radioembolization and that downstaging of malignancy allowed for resection in a number of their patients.…”