Treatment of unresectable intrahepatic cholangiocarcinoma with yttrium-90 radioembolization: A systematic review and pooled analysis

Abstract Radioembolization with yttrium-90 microspheres offers an alternative treatment option for patients with unresectable intrahepatic cholangiocarcinoma (ICC). However, the rarity and heterogeneity of ICC makes it difficult to draw firm conclusions about treatment efficacy. Therefore, the goal...

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Bibliographic Details
Published in:	European journal of surgical oncology Vol. 41; no. 1; pp. 120 - 127
Main Authors:	Al-Adra, D.P, Gill, R.S, Axford, S.J, Shi, X, Kneteman, N, Liau, S.-S
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-01-2015 Elsevier
Subjects:	Bile Duct Neoplasms - therapy Bile Ducts, Intrahepatic Cholangiocarcinoma Cholangiocarcinoma - therapy Disease-Free Survival Embolization, Therapeutic - methods Hematology, Oncology and Palliative Medicine Humans Microspheres Radioembolization Radiopharmaceuticals - therapeutic use Surgery Treatment Outcome Yttrium Radioisotopes - therapeutic use Yttrium-90 microsphere Radioembolization Yttrium-90 microsphere Cholangiocarcinoma
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Summary:	Abstract Radioembolization with yttrium-90 microspheres offers an alternative treatment option for patients with unresectable intrahepatic cholangiocarcinoma (ICC). However, the rarity and heterogeneity of ICC makes it difficult to draw firm conclusions about treatment efficacy. Therefore, the goal of the current study is to systematically review the existing literature surrounding treatment of unresectable ICCs with yttrium-90 microspheres and provide a comprehensive review of the current experience and clinical outcome of this treatment modality. We performed a comprehensive search of electronic databases for ICC treatment and identified 12 studies with relevant data regarding radioembolization therapy with yttrium-90 microspheres. Based on pooled analysis, the overall weighted median survival was 15.5 months. Tumour response based on radiological studies demonstrated a partial response in 28% and stable disease in 54% of patients at three months. Seven patients were able to be downstaged to surgical resection. The complication profile of radioembolization is similar to that of other intra-arterial treatment modalities. Overall survival of patients with ICC after treatment with yttrium-90 microspheres is higher than historical survival rates and shows similar survival to those patients treated with systemic chemotherapy and/or trans-arterial chemoembolization therapy. Therefore, the use of yttrium-90 microspheres should be considered in the list of available treatment options for ICC. However, future randomized trials comparing systemic chemotherapy, TACE and local radiation will be required to identify the optimal treatment modality for unresectable ICC.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-Review-4 content type line 23 ObjectType-Undefined-3
ISSN:	0748-7983 1532-2157
DOI:	10.1016/j.ejso.2014.09.007