title: Yttrium-90 radioembolization for intrahepatic cholangiocarcinoma: safety, response, and survival analysis.
abstract: OBJECTIVE
  To present data on safety, antitumoral response, and survival following yttrium-90 ((90)Y) radioembolization for patients with unresectable intrahepatic cholangiocarcinoma (ICC).
  
  
  METHODS
  The present study expands on the cohort of 24 patients with ICC described in a pilot study, and includes 46 patients treated with (90)Y radioembolization at a single institution during an 8-year period. Via retrospective review of a prospectively collected database, patients were stratified by performance status, tumor distribution (solitary or multifocal), tumor morphology (infiltrative or peripheral), and presence/absence of portal vein thrombosis. Primary endpoints included biochemical and clinical toxicities, and secondary endpoints included imaging response (World Health Organization [WHO] and European Association for the Study of Liver Disease [EASL] criteria) and survival. Uni-/multivariate analyses were performed.
  
  
  RESULTS
  Ninety-two treatments were performed, with a mean of two per patient. Fatigue and transient abdominal pain occurred in 25 patients (54%) and 13 patients (28%), respectively. Treatment-related gastroduodenal ulcer developed in one patient (2%). WHO imaging findings included partial response (n = 11; 25%), stable disease (n = 33; 73%), and progressive disease (n = 1; 2%). EASL imaging findings included partial/complete response (n = 33; 73%) and stable disease (n = 12; 27%). Survival varied based on presence of multifocal (5.7 mo vs 14.6 mo), infiltrative (6.1 mo vs 15.6 mo), and bilobar disease (10.9 mo vs 11.7 mo). Disease was converted to resectable status in five patients, who successfully underwent curative (ie, R0) resection.
  
  
  CONCLUSIONS
  Radioembolization with (90)Y is safe and demonstrates antitumoral response and survival benefit in select patients with ICC. Results are most pronounced in patients with solitary tumors, for whom conversion to curative resection is possible.
authors.affiliation: Department of Radiology/Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA.
authors.forename: Samdeep
authors.initials: S
authors.lastname: Mouli
authors.forename: Khairuddin
authors.initials: K
authors.lastname: Memon
authors.forename: Talia
authors.initials: T
authors.lastname: Baker
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Ramona
authors.initials: R
authors.lastname: Gupta
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes
keywords: CTCAE; Common Terminology Criteria for Adverse Events; EASL; ECOG; Eastern Cooperative Oncology Group; European Association for the Study of the Liver; ICC; OS; PS; RECIST; Response Evaluation Criteria In Solid Tumors; WHO; World Health Organization; intrahepatic cholangiocarcinoma; overall survival; performance status