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

Abstract

Purpose: To evaluate the value of resin-based yttrium-90 (⁹⁰Y) radioembolization for unresectable and failed first-line chemotherapy (cisplatin plus gemcitabine) intrahepatic cholangiocarcinoma (ICC).

Methods: 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.

Results: 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 ± 0.4 GBq with a total of 27 treatments. Disease control rate was 81.8% at 3 months 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 1 month 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 ± 6.6 months, 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 9.0 months, 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.

Conclusions: Resin-based ⁹⁰Y radioembolization can provide palliative control of unresectable and failed first-line chemotherapy ICC in a salvage setting with acceptable side effects.

Keywords: Cholangiocarcinoma; Radioembolization; SIRspheres; Side effects; Yttrium-90.

Fig. 1

Cumulative survival curve of the 24 patients after ⁹⁰Y therapy

Fig. 2

Cumulative survival after Y90 radioembolization categorized by ECOG performance status

Fig. 3

Cumulative survival after Y90 radioembolization categorized by the presence or absence of lymph node metastases