Yttrium-90 Radioembolization for Unresectable Combined Hepatocellular-Cholangiocarcinoma

• Published in: Cardiovascular and interventional radiology 2017-09, Vol.40 (9), p.1383-1391
• Main Authors: Chan, Lauren S., Sze, Daniel Y., Poultsides, George A., Louie, John D., Abdelrazek Mohammed, Mohammed A., Wang, David S.
• Format: Article
• Language: English
• Subjects: Aged; Anorexia; Bile Duct Neoplasms - therapy; BIOLOGICAL MARKERS; Biomarkers; Carcinoma, Hepatocellular - therapy; Cardiology; Chemoembolization, Therapeutic - methods; Chemoradiotherapy - methods; Cholangiocarcinoma; Cholangiocarcinoma - therapy; Clinical Investigation; Criteria; Fatigue; Female; Hepatocellular carcinoma; Hepatocytes; Humans; Imaging; Liver; Liver cancer; Liver Neoplasms - therapy; Male; Medicine; Medicine & Public Health; MICROSPHERES; Middle Aged; Nausea; NEOPLASMS; Nuclear Medicine; Pain; PATIENTS; Quality; RADIOEMBOLIZATION; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Retrospective Studies; Solid tumors; Survival; TOXICITY; Tumors; Ultrasound; Yttrium; YTTRIUM 90; Yttrium Radioisotopes - therapeutic use
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-017-1648-7

Purpose Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare mixed cell type primary liver cancer with limited data to guide management. Transarterial radioembolization with yttrium-90 microspheres (RE) is an emerging treatment option for both hepatocellular carcinoma and intrahepatic cholangiocarcinoma. This study explored the safety and efficacy of RE for unresectable cHCC-CC. Methods Patients with histopathologically confirmed cHCC-CC treated with RE were retrospectively evaluated. Clinical and biochemical toxicities were assessed using the Common Toxicity Criteria for Adverse Events v4.03. Radiological response was analyzed using the Response Criteria in Solid Tumors (RECIST) v1.1 and modified RECIST criteria. Survival times were calculated and prognostic variables identified. Results Ten patients (median age 59 years; six men, four women) with unresectable cHCC-CC underwent 14 RE treatments with resin ( n  = 6 patients) or glass ( n  = 4 patients) microspheres. Clinical toxicities were limited to grade 1–2 fatigue, anorexia, nausea, or abdominal pain. No significant biochemical toxicities were observed. Median overall survivals from the first RE treatment and from initial diagnosis were 10.2 and 17.7 months, respectively. Six of seven patients with elevated tumor biomarker levels before RE showed decreased levels after treatment (median decrease of 72%, range 13–80%). Best hepatic radiological response was 60% partial response and 40% stable disease by modified RECIST, and 100% stable disease by RECIST v1.1. Poor performance status and the presence of macrovascular invasion were identified as predictors of reduced survival after RE. Conclusion RE appears to be a safe and promising treatment option for patients with unresectable cHCC-CC. Level of Evidence Level 4.