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.

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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.

Reference

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

intrahepatic cholangiocarcinoma