Unresectable Intrahepatic Cholangiocarcinoma Treated with Radiation Segmentectomy/Lobectomy Using Yttrium 90-labeled Glass Microspheres

Premsai Kumar; Rahul Mhaskar; Richard Kim; Daniel Anaya; Jessica Frakes; Sarah Hoffe; Junsung Choi; Bela Kis

doi:10.1016/j.jceh.2022.03.008

Unresectable Intrahepatic Cholangiocarcinoma Treated with Radiation Segmentectomy/Lobectomy Using Yttrium 90-labeled Glass Microspheres

J Clin Exp Hepatol. 2022 Sep-Oct;12(5):1259-1263. doi: 10.1016/j.jceh.2022.03.008. Epub 2022 Apr 1.

Authors

Premsai Kumar^{1

2}, Rahul Mhaskar², Richard Kim³, Daniel Anaya³, Jessica Frakes⁴, Sarah Hoffe⁴, Junsung Choi¹, Bela Kis¹

Affiliations

¹ Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA.
² University of South Florida Morsani College of Medicine, Tampa, FL, USA.
³ Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA.
⁴ Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA.

Abstract

Background: There is no curative treatment option for patients with unresectable intrahepatic, cholangiocarcinoma (IHC). The aim of this study was to evaluate the efficacy of; radiation segmentectomy/lobectomy using Y90-labeled glass microspheres in patients with; unresectable IHC.

Methods: This IRB-approved, single-center study included, 16 patients (age: 67 ± 7.7 years) with IHC who received radiation segmentectomy or lobectomy, treatment using Y90-labeled glass microspheres between May 2009 and October 2019. Radiation, segmentectomy/lobectomy was defined as at least 190 Gy dose delivered into treated liver; volume.

Results: The median OS from IHC diagnosis was 22.7 months (95% CI: 13.9-66.1) and from, radioembolization it was 7 months (95% CI: 4.33-54.17). Patients who did not receive, chemotherapy before the radioembolization had significantly longer median OS (26.8 vs. 5.9, months, P = 0.03). Four patients had >20 months survival after radioembolization, including 2, patients with survival of 42 and 54 months. There was no 30-day mortality and no severe, complications.

Conclusion: Radiation segmentectomy/lobectomy is safe with minimal side effects. The median, OS of the study group is modest; however, 4 patients (25%) showed excellent survival. These results suggest a need for a larger study to define the IHC patient group who could, most benefit from this procedure.

Keywords: ECOG, Eastern Cooperative Oncology Group; Gy, Gray; HCC, Hepatocellular Carcinoma; IHC, Intrahepatic Cholangiocarcinoma; INR, International Normalized Ratio; IRB, Institutional Review Board; OS, Overall Survival; TARE, Transarterial Radioembolization; Y90, Yttrium 90; cholangiocarcinoma; liver; radiation lobectomy; radiation segmentectomy; radioembolization.