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Digestive Disease Interventions 2021; 05(02): 093-102
DOI: 10.1055/s-0041-1729874
Review Article

Radioembolization for Cholangiocarcinoma

Aamir Ali
1   Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
,
Komal Manzoor
1   Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
,
Jeffrey L. Weinstein
1   Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
,
Salomao Faintuch
1   Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
,
Muneeb Ahmed
1   Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
,
Ammar Sarwar
1   Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
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Abstract

Cholangiocarcinoma is the second most common primary hepatic malignancy which accounts for 13% of total cancer mortality worldwide. Surgical resection is the only curative treatment for localized disease; however, the majority of patients present when the tumor is unresectable. The incidence of the intrahepatic subtype of cholangiocarcinoma is increasing worldwide. Current standard of care in patients with unresectable intrahepatic cholangiocarcinoma is systemic chemotherapy; however, yttrium-90 transarterial radioembolization (Y90-TARE) is under investigation for the treatment of intrahepatic cholangiocarcinoma with promising trials and published clinical experience. This review critically evaluates the role of Y90-TARE in the management of intrahepatic cholangiocarcinoma.

Keywords

cholangiocarcinoma - yttrium-90 - radioembolization


Publication History

Received: 10 February 2021

Accepted: 18 March 2021

Article published online:
08 May 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Banales JM, Marin JJG, Lamarca A. et al. Cholangiocarcinoma 2020: the next horizon in mechanisms and management. Nat Rev Gastroenterol Hepatol 2020; 17 (09) 557-588
    Google Scholar
  • 2 Kirstein MM, Vogel A. Epidemiology and risk factors of cholangiocarcinoma. Visc Med 2016; 32 (06) 395-400
    CrossrefPubMedGoogle Scholar
  • 3 Rizvi S, Khan SA, Hallemeier CL, Kelley RK, Gores GJ. Cholangiocarcinoma - evolving concepts and therapeutic strategies. Nat Rev Clin Oncol 2018; 15 (02) 95-111
    CrossrefPubMedGoogle Scholar
  • 4 Valle J, Wasan H, Palmer DH. et al; ABC-02 Trial Investigators. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 2010; 362 (14) 1273-1281
    CrossrefPubMedGoogle Scholar
  • 5 Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet 2014; 383 (9935): 2168-2179
    CrossrefPubMedGoogle Scholar
  • 6 Lamarca A, Ross P, Wasan HS. et al. Advanced intrahepatic cholangiocarcinoma: post hoc analysis of the ABC-01, -02, and -03 clinical trials. J Natl Cancer Inst 2020; 112 (02) 200-210
    PubMedGoogle Scholar
  • 7 Padia SA, Lewandowski RJ, Johnson GE. et al; Society of Interventional Radiology Standards of Practice Committee. Radioembolization of hepatic malignancies: background, quality improvement guidelines, and future directions. J Vasc Interv Radiol 2017; 28 (01) 1-15
    CrossrefPubMedGoogle Scholar
  • 8 Saxena A, Bester L, Chua TC, Chu FC, Morris DL. Yttrium-90 radiotherapy for unresectable intrahepatic cholangiocarcinoma: a preliminary assessment of this novel treatment option. Ann Surg Oncol 2010; 17 (02) 484-491
    CrossrefPubMedGoogle Scholar
  • 9 Haug AR, Heinemann V, Bruns CJ. et al. 18F-FDG PET independently predicts survival in patients with cholangiocellular carcinoma treated with 90Y microspheres. Eur J Nucl Med Mol Imaging 2011; 38 (06) 1037-1045
    CrossrefPubMedGoogle Scholar
  • 10 Hoffmann R-T, Paprottka PM, Schön A. et al. Transarterial hepatic yttrium-90 radioembolization in patients with unresectable intrahepatic cholangiocarcinoma: factors associated with prolonged survival. Cardiovasc Intervent Radiol 2012; 35 (01) 105-116
    CrossrefPubMedGoogle Scholar
  • 11 Rafi S, Piduru SM, El-Rayes B. et al. Yttrium-90 radioembolization for unresectable standard-chemorefractory intrahepatic cholangiocarcinoma: survival, efficacy, and safety study. Cardiovasc Intervent Radiol 2013; 36 (02) 440-448
    CrossrefPubMedGoogle Scholar
  • 12 Mouli S, Memon K, Baker T. et al. Yttrium-90 radioembolization for intrahepatic cholangiocarcinoma: safety, response, and survival analysis. J Vasc Interv Radiol 2013; 24 (08) 1227-1234
    CrossrefPubMedGoogle Scholar
  • 13 Camacho JC, Kokabi N, Xing M, Prajapati HJ, El-Rayes B, Kim HS. Modified response evaluation criteria in solid tumors and European Association for the Study of the Liver criteria using delayed-phase imaging at an early time point predict survival in patients with unresectable intrahepatic cholangiocarcinoma following yttrium-90 radioembolization. J Vasc Interv Radiol 2014; 25 (02) 256-265
    CrossrefPubMedGoogle Scholar
  • 14 Filippi L, Pelle G, Cianni R, Scopinaro F, Bagni O. Change in total lesion glycolysis and clinical outcome after (90)Y radioembolization in intrahepatic cholangiocarcinoma. Nucl Med Biol 2015; 42 (01) 59-64
    CrossrefPubMedGoogle Scholar
  • 15 Soydal C, Kucuk ON, Bilgic S, Ibis E. Radioembolization with (90)Y resin microspheres for intrahepatic cholangiocellular carcinoma: prognostic factors. Ann Nucl Med 2016; 30 (01) 29-34
    CrossrefPubMedGoogle Scholar
  • 16 Jia Z, Paz-Fumagalli R, Frey G, Sella DM, McKinney JM, Wang W. Resin-based yttrium-90 microspheres for unresectable and failed first-line chemotherapy intrahepatic cholangiocarcinoma: preliminary results. J Cancer Res Clin Oncol 2017; 143 (03) 481-489
    CrossrefPubMedGoogle Scholar
  • 17 Swinburne NC, Biederman DM, Besa C. et al. Radioembolization for unresectable intrahepatic cholangiocarcinoma: review of safety, response evaluation criteria in solid tumors 1.1 imaging response and survival. Cancer Biother Radiopharm 2017; 32 (05) 161-168
    CrossrefPubMedGoogle Scholar
  • 18 Shaker TM, Chung C, Varma MK. et al. Is there a role for yttrium-90 in the treatment of unresectable and metastatic intrahepatic cholangiocarcinoma?. Am J Surg 2018; 215 (03) 467-470
    CrossrefPubMedGoogle Scholar
  • 19 Reimer P, Virarkar MK, Binnenhei M, Justinger M, Schön MR, Tatsch K. Prognostic factors in overall survival of patients with unresectable intrahepatic cholangiocarcinoma treated by means of yttrium-90 radioembolization: results in therapy-naïve patients. Cardiovasc Intervent Radiol 2018; 41 (05) 744-752
    CrossrefPubMedGoogle Scholar
  • 20 Gangi A, Shah J, Hatfield N. et al. Intrahepatic cholangiocarcinoma treated with transarterial yttrium-90 glass microsphere radioembolization: results of a single institution retrospective study. J Vasc Interv Radiol 2018; 29 (08) 1101-1108
    CrossrefPubMedGoogle Scholar
  • 21 Bourien H, Palard X, Rolland Y. et al. Yttrium-90 glass microspheres radioembolization (RE) for biliary tract cancer: a large single-center experience. Eur J Nucl Med Mol Imaging 2019; 46 (03) 669-676
    CrossrefPubMedGoogle Scholar
  • 22 White J, Carolan-Rees G, Dale M. et al. Yttrium-90 transarterial radioembolization for chemotherapy-refractory intrahepatic cholangiocarcinoma: a prospective, observational study. J Vasc Interv Radiol 2019; 30 (08) 1185-1192
    CrossrefPubMedGoogle Scholar
  • 23 Levillain H, Duran Derijckere I, Ameye L. et al. Personalised radioembolization improves outcomes in refractory intra-hepatic cholangiocarcinoma: a multicenter study. Eur J Nucl Med Mol Imaging 2019; 46 (11) 2270-2279
    CrossrefPubMedGoogle Scholar
  • 24 Edeline J, Touchefeu Y, Guiu B. et al. Radioembolization plus chemotherapy for first-line treatment of locally advanced intrahepatic cholangiocarcinoma: a phase 2 clinical trial. JAMA Oncol 2019; 6 (01) 51
    CrossrefPubMedGoogle Scholar
  • 25 Filippi L, Di Costanzo GG, Tortora R. et al. Prognostic value of neutrophil-to-lymphocyte ratio and its correlation with fluorine-18-fluorodeoxyglucose metabolic parameters in intrahepatic cholangiocarcinoma submitted to 90Y-radioembolization. Nucl Med Commun 2020; 41 (01) 78-86
    CrossrefPubMedGoogle Scholar
  • 26 Köhler M, Harders F, Lohöfer F. et al. Prognostic factors for overall survival in advanced intrahepatic cholangiocarcinoma treated with yttrium-90 radioembolization. J Clin Med 2019; 9 (01) 56
    CrossrefPubMedGoogle Scholar
  • 27 Mosconi C, Cucchetti A, Bruno A. et al. Radiomics of cholangiocarcinoma on pretreatment CT can identify patients who would best respond to radioembolisation. Eur Radiol 2020; 30 (08) 4534-4544
    CrossrefPubMedGoogle Scholar
  • 28 Buettner S, Braat AJAT, Margonis GA. et al. Yttrium-90 radioembolization in intrahepatic cholangiocarcinoma: a multicenter retrospective analysis. J Vasc Interv Radiol 2020; 31 (07) 1035-1043.e2
    CrossrefPubMedGoogle Scholar
  • 29 Rayar M, Sulpice L, Edeline J. et al. Intra-arterial yttrium-90 radioembolization combined with systemic chemotherapy is a promising method for downstaging unresectable huge intrahepatic cholangiocarcinoma to surgical treatment. Ann Surg Oncol 2015; 22 (09) 3102-3108
    CrossrefPubMedGoogle Scholar
  • 30 Riby D, Mazzotta AD, Bergeat D. et al. Downstaging with radioembolization or chemotherapy for initially unresectable intrahepatic cholangiocarcinoma. Ann Surg Oncol 2020; 27 (10) 3729-3737
    CrossrefPubMedGoogle Scholar
  • 31 Nezami N, Kokabi N, Camacho JC, Schuster DM, Xing M, Kim HS. 90Y radioembolization dosimetry using a simple semi-quantitative method in intrahepatic cholangiocarcinoma: glass versus resin microspheres. Nucl Med Biol 2018; 59: 22-28
    CrossrefPubMedGoogle Scholar
  • 32 Akinwande O, Shah V, Mills A. et al. Chemoembolization versus radioembolization for the treatment of unresectable intrahepatic cholangiocarcinoma in a single institution image-based efficacy and comparative toxicity. Hepat Oncol 2017; 4 (03) 75-81
    CrossrefPubMedGoogle Scholar
  • 33 Ghodadra A, Xing M, Zhang D, Kim HS. Yttrium-90 radioembolization is cost effective in intrahepatic cholangiocarcinoma: a SEER Medicare Population Study. J Vasc Interv Radiol 2019; 30 (03) 293-297
    CrossrefPubMedGoogle Scholar
  • 34 Sebastian NT, Tan Y, Miller ED, Williams TM, Alexandra Diaz D. Stereotactic body radiation therapy is associated with improved overall survival compared to chemoradiation or radioembolization in the treatment of unresectable intrahepatic cholangiocarcinoma. Clin Transl Radiat Oncol 2019; 19: 66-71
    CrossrefPubMedGoogle Scholar
  • 35 Tong AKT, Kao YH, Too CW, Chin KFW, Ng DCE, Chow PKH. Yttrium-90 hepatic radioembolization: clinical review and current techniques in interventional radiology and personalized dosimetry. Br J Radiol 2016; 89 (1062): 20150943
    CrossrefPubMedGoogle Scholar
  • 36 Sarwar A, Kudla A, Weinstein JL. et al. Yttrium-90 radioembolization using MIRD dosimetry with resin microspheres. Eur Radiol 2021; 31 (03) 1316-1324
    CrossrefPubMedGoogle Scholar
  • 37 Hickey R, Vouche M, Sze DY. et al. Cancer concepts and principles: primer for the interventional oncologist-part I. J Vasc Interv Radiol 2013; 24 (08) 1157-1164
    CrossrefPubMedGoogle Scholar
  • 38 Owens DK. Interpretation of cost-effectiveness analyses. J Gen Intern Med 1998; 13 (10) 716-717
    CrossrefPubMedGoogle Scholar
  • 39 Eichler H-G, Kong SX, Gerth WC, Mavros P, Jönsson B. Use of cost-effectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge?. Value Health 2004; 7 (05) 518-528
    CrossrefPubMedGoogle Scholar