title: Yttrium-90 radiotherapy for unresectable intrahepatic cholangiocarcinoma: a preliminary assessment of this novel treatment option.
abstract: BACKGROUND
  There are no treatment options for unresectable intrahepatic cholangiocarcinoma (ICC) with proven efficacy. The objective of this study was to present data on the safety and efficacy of a novel treatment option, yttrium-90 ((90)Y) radioembolization for unresectable ICC.
  
  
  METHODS
  Twenty-five patients underwent resin-based (90)Y radioembolization for unresectable ICC between January 2004 and May 2009. Patients were assessed at 1 month and then at 3-month intervals after treatment. Radiologic response was evaluated with the Response Criteria in Solid Tumors (RECIST) criteria. Clinical and biochemical toxicities were prospectively recorded. Survival was calculated by the Kaplan-Meier method and potential prognostic variables were identified.
  
  
  RESULTS
  No patient was lost to follow-up. The median follow-up was 8.1 (range, 0.4-56) months and the median survival after (90)Y radioembolization was 9.3 months. Two patients died within 1 month of treatment; the median follow-up for the remaining 23 was 8.9 (range, 1.5-56) months. Two factors were associated with an improved survival: peripheral tumor type (vs. infiltrative, P = .004) and Eastern Cooperative Oncology Group performance status of 0 (vs. 1 and 2, P < .001). On imaging follow-up of 23 patients, a partial response to treatment was observed in 6 patients (24%), stable disease in 11 patients (48%), and progressive disease in 5 patients (20%). The most common clinical toxicities were fatigue (64%) and self-limiting abdominal pain (40%). Two patients (8%) each developed grade III bilirubin and albumin toxicity. One patient (4%) developed grade III alkaline phosphatase toxicity.
  
  
  CONCLUSIONS
  (90)Y radioembolization may be a relatively safe and efficacious treatment for unresectable ICC. In the absence of other effective therapeutic options, this treatment warrants further investigation.
authors.affiliation: Department of Surgery, St. George Hospital, University of New South Wales, Sydney, NSW, Australia. a.saxena@ugrad.unimelb.edu.au
authors.forename: Akshat
authors.initials: A
authors.lastname: Saxena
authors.forename: Lourens
authors.initials: L
authors.lastname: Bester
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
authors.forename: Francis C
authors.initials: FC
authors.lastname: Chu
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D001650:Bile Duct Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000528:radiation effects*; D018281:Cholangiocarcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes