The use of first-line, neoadjuvant yttrium-90 transarterial radioembolization (Y90-TARE) with resin microspheres in patients with intrahepatic cholangiocarcinoma (iCC) showed good survival outcomes. It also allowed for R0 resection margins with anatomical resections for unresectable tumors.
“This study demonstrates a high disease control rate (86%) at 6 months, median [overall survival] (22 months), downstaging to resection (11/21; 52%), R0 resection margin (8/11; 73%), and low rates of extended hepatectomy (4/11; 36%) when using Y90-TARE in conjunction with systemic chemotherapy as first-line therapy,” for iCC,” Sarwar et al concluded.
Read more about cholangiocarcinoma therapies
Y90-TARE was prescribed to 31 patients with iCC (median age, 69 years, 65% male) using the Medical Internal Radiation Dose (MIRD) model. Y90-TARE was used as first-line treatment in 74% of patients. The remaining patients were treated with chemotherapy, radiofrequency ablation, or resection followed by stereotactic body radiation therapy and chemotherapy prior to Y90-TARE.
The prescribed Y90-TARE regimen achieved ≥90% pathologic necrosis in 70% of patients who underwent surgical resection. Patients who underwent surgical resection received Y90-TARE as a first-line treatment prior to chemotherapy (55%) or as a standalone treatment (36%). The median time to disease progression in patients receiving Y90-TARE as a first-line therapy was 12.7 months. The 3-year overall survival rate was 21%.
The single-center retrospective study published in the Journal of Vascular and Interventional Radiology highlighted 3 main advantages for the use of Y90-TARE as a first-line treatment:
- High rates of complete pathological necrosis, which allows for local control without significant toxicity; this may affect the outcomes of subsequent surgical resection
- Evaluation of progression-free survival after dosing helps to assess tumor biology and select patients for surgical resection
- It can help to limit toxicity associated with systemic chemotherapy by reducing the drug dose or the number of cycles required.
Sarwar A, Ali A, Ljuboja D, et al. Neoadjuvant yttrium-90 transarterial radioembolization with resin microspheres prescribed using the MIRD model for intrahepatic cholangiocarcinoma. J Vasc Interv Radiol. Published online August 25, 2021. doi:10.1016/j.jvir.2021.08.009