Resin-based Yttrium-90 microspheres for unresectable and failed first-line chemotherapy intrahepatic cholangiocarcinoma: preliminary results.

Abstract

To evaluate the value of resin-based yttrium-90 (90Y) radioembolization for unresectable and failed first-line chemotherapy (cisplatin plus gemcitabine) intrahepatic cholangiocarcinoma (ICC). From February 2006 to September 2015, a retrospective study was conducted of all patients who underwent resin-based 90Y therapy for unresectable and failed first-line chemotherapy ICC. Tumor response was assessed using modified RECIST criteria; side effects were assessed using Common Terminology Criteria for Adverse Events version 4.03; survivals were calculated from the date of diagnosis of ICC, beginning of first-line chemotherapy and first 90Y procedure, respectively; effects of factors on survival were analyzed by Cox regression model. Twenty-four patients (eight male and 16 female) were included in this study. Mean 5.6±1.6 cycles of first-line chemotherapy were performed prior to 90Y treatment. The mean delivered activity of 90Y was 1.6±0.4GBq with a total of 27 treatments. Disease control rate was 81.8% at 3months after 90Y therapy, with partial response (n=8, 36.4%), stable disease (n=10, 45.5%) and progressive disease (n=6, 18.2%). CA199 changes pre- and 1month post-treatment were complete (n=2), partial (n=2), none (n=5) and progression (n=2), respectively. Side effects included fatigue (n=21, 87.5%), anorexia (n=19, 79.2%), nausea (n=15, 62.5%), abdominal pain (n=10, 58.3%), vomiting (n=4, 16.7%) and fever (n=3, 12.5%). Radiation-induced gastrointestinal ulcer was identified in one patient. The mean follow-up was 11.3±6.6months, and the median survivals from the time of diagnosis of ICC, beginning of first-line chemotherapy and first 90Y procedure were 24.0, 16.0 and 9.0months, respectively, and the 6-, 12-, 18-, 24- and 30-month survival after 90Y therapy were 69.9, 32.6, 27.2, 20.4 and 20.4%, respectively. ECOG performance status (P=0.002) and lymph node metastases (P=0.019) had statistically significant influence on overall survival. Resin-based 90Y radioembolization can provide palliative control of unresectable and failed first-line chemotherapy ICC in a salvage setting with acceptable side effects.