Outcome and Safety after 103 Radioembolizations with Yttrium-90 Resin Microspheres in 73 Patients with Unresectable Intrahepatic Cholangiocarcinoma-An Evaluation of Predictors.

Karolin J. Paprottka,Andrei Todica,Franziska Galiè,Michael Ingrisch,Harun Ilhan,Marlies Michl,Tobias Geith,Philipp M. Paprottka,Jonathan Nadjiri

doi:10.3390/cancers13215399

Abstract

Simple SummaryTARE with yttrium-90 (90Y) resin microspheres is emerging in many countries as a treatment option for ICC. Identification of patients that will benefit from TARE is a clinically relevant problem with individual but also economical relevance. The aim of this study was to detect outcome predictors for patients with ICC after TARE with 90Y resin microspheres. We found TARE with 90Y resin microspheres to be a safe treatment option for unresectable ICC. Predictive factors for TARE in ICC are CA-19-9 response, tumor burden, and cholinesterase. Multiple TARE sessions might further improve overall survival.Trans-arterial radioembolization (TARE) is increasingly evaluated for unresectable intrahepatic cholangiocarcinoma (ICC). Not all ICC patients benefit equally well from TARE. Therefore, we sought to evaluate variables predicting progression-free survival (PFS) and overall survival (OS). Patients with non-resectable ICC underwent TARE and were treated with 90Y resin microspheres. Baseline characteristics, biochemical/clinical toxicities, and response were examined for impact on PFS and OS. A total of 103 treatments were administered to 73 patients without major complications or toxicity. Mean OS was 18.9 months (95% confidence intervals (CI); 13.9–23.9 months). Mean and median PFS were 10.1 months (95% CI; 7.9–12.2) and 6.4 months (95% CI; 5.20–7.61), respectively. Median OS and PFS were significantly prolonged in patients with baseline cholinesterase (CHE) ≥ 4.62 kU/L (OS: 14.0 vs. 5.5 months; PFS: 6.9 vs. 3.2 months; p < 0.001). Patients with a tumor burden ≤ 25% had a significantly longer OS (15.2 vs. 6.6 months; p = 0.036). Median PFS was significantly longer for patients with multiple TARE cycles (24.4 vs. 5.8 months; p = 0.04). TARE is a considerable and safe option for unresectable ICC. CA-19-9, CHE, and tumor burden have predictive value for survival in patients treated with TARE. Multiple TARE treatments might further improve survival; this has to be confirmed by further studies.

Highlights

Intrahepatic cholangiocarcinoma (ICC) is a rare disease with approximately 3000 cases diagnosed every year in the USA [1,2]
Inclusion criteria were defined as follows: non-resectable intrahepatic cholangiocarcinoma (ICC) determined in an interdisciplinary tumor board; absence of significant extrahepatic disease (EHD); failure to respond to other types of medical, surgical, or local ablative treatment modalities; no portal vein occlusion; adequate biochemical and hematological function; no relevant comorbidities; and written, informed consent
MBSA was recommended by a consensus report as the most appropriate method avoiding the rare occurrence of radioembolization-induced liver disease (REILD)

Summary

Introduction

Intrahepatic cholangiocarcinoma (ICC) is a rare disease with approximately 3000 cases diagnosed every year in the USA [1,2]. ICC is the second most common primary liver cancer and accounts for approximately 10–20% of all primary liver tumors [3]. Only 20% of patients with ICC are eligible for resection due to anatomic location, disease spread, inadequate hepatic reserve, or limiting comorbidities [4,5,6]. Median survival for patients with untreated unresectable ICC has been reported to be between 3–6 months [6,7]. It is of note that survival for liver-only ICC is relevantly different from other bile duct cancers [8]

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