title: Transarterial hepatic yttrium-90 radioembolization in patients with unresectable intrahepatic cholangiocarcinoma: factors associated with prolonged survival.
abstract: BACKGROUND
  In unresectable intrahepatic cholangiocarcinoma (ICC), systemic chemotherapy often is viewed as the only option, although efficacy is limited. Radioembolization (RE) using yttrium-90 ((90)Y) microspheres is an accepted therapy for patients with hepatocellular-carcinoma or metastatic liver tumors. However, there are limited data on the value of RE in patients with ICC and few data on factors influencing prognosis. The purpose of our retrospective analysis was to establish which factors influenced time-to-progression (TTP) and overall survival (OS).
  
  
  METHODS
  Patients with unresectable ICC were treated with (90)Y resin-microspheres and assessed at 3-monthly intervals. Radiologic response was evaluated by using Response Criteria in Solid Tumors (RECIST). Baseline characteristics, biochemical/clinical toxicities, and response were examined for impact on TTP and OS.
  
  
  RESULTS
  Thirty-four treatments were administered to 33 patients without major complications. By RECIST, 12 patients had a partial response, 17 had stable disease, and 5 had progressive disease after 3 months. The median OS was 22 months posttreatment and 43.7 months postdiagnosis. Median TTP was 9.8 months. Survival and TTP were significantly prolonged in patients with ECOG 0 (vs. ECOG 1 or 2; median OS: 29.4, 10, and 5.1 months; TTP: 17.5, 6.9, and 2.4 months), tumor burden ≤25% (OS: 26.7 vs. 6 months; TTP: 17.5 vs. 2.3 months), or tumor response (PR or SD vs. PD; OS: 35.5, 17.7 vs. 5.7 months; TTP: 31.9, 9.8 vs. 2.5 months), respectively (P < 0.001).
  
  
  CONCLUSIONS
  Radioembolization is an effective and safe option for patients with unresectable ICC. Predictors for prolonged survival are performance status, tumor burden, and RECIST response.
authors: Institute of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany. rthoffma@med.uni-muenchen.de
authors: Ralf-T
authors: RT
authors: Hoffmann
authors: Philipp M
authors: PM
authors: Paprottka
authors: Agnes
authors: A
authors: Schön
authors: Fabian
authors: F
authors: Bamberg
authors: Alexander
authors: A
authors: Haug
authors: Eva-Maria
authors: EM
authors: Dürr
authors: Barbara
authors: B
authors: Rauch
authors: Christoph T
authors: CT
authors: Trumm
authors: Tobias F
authors: TF
authors: Jakobs
authors: Thomas K
authors: TK
authors: Helmberger
authors: Maximilian F
authors: MF
authors: Reiser
authors: Frank T
authors: FT
authors: Kolligs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000473:pathology / Q000528:radiation effects*; D014408:Biomarkers, Tumor / Q000032:analysis; D018395:CA-19-9 Antigen / Q000032:analysis; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D015021:Yttrium Radioisotopes