Research Papers:

Safety and initial efficacy of ablative radioembolization for the treatment of unresectable intrahepatic cholangiocarcinoma

Ricardo Paz-Fumagalli _, Jacob Core, Carlos Padula, Seyed Montazeri, John McKinney, Gregory Frey, Zlatko Devcic, Andrew Lewis, Charles Ritchie, Kabir Mody, Sunil Krishnan and Beau Toskich

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Oncotarget. 2021; 12:2075-2088. https://doi.org/10.18632/oncotarget.28060

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Ricardo Paz-Fumagalli1, Jacob Core1, Carlos Padula1, Seyed Montazeri1, John McKinney1, Gregory Frey1, Zlatko Devcic1, Andrew Lewis1, Charles Ritchie1, Kabir Mody2, Sunil Krishnan3 and Beau Toskich1

1 Department of Radiology, Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, FL 32224, USA

2 Division of Medical Oncology, Mayo Clinic Florida, Jacksonville, FL 32224, USA

3 Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL 32224, USA

Correspondence to:

Ricardo Paz-Fumagalli, email: [email protected]

Keywords: Yttrium-90; radioembolization; cholangiocarcinoma; angiography; radiation dosimetry

Received: June 30, 2021     Accepted: August 18, 2021     Published: September 28, 2021

Copyright: © 2021 Paz-Fumagalli et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Purpose: To investigate safety, response, and survival after ablative glass microsphere 90Y radioembolization for unresectable intrahepatic cholangiocarcinoma.

Materials and Methods: A retrospective review of 37 radioembolizations in 28 patients treated with single compartment dose of ≥190 Gy encompassing >75% of the largest tumor was performed. Tumors were assessed for stage, morphology, and arterial supply. Response per Modified Response Evaluation Criteria in Solid Tumors (mRECIST), freedom from progression (FFP), progression-free survival (PFS), overall survival (OS), biochemical hepatic function, performance status, and adverse events were investigated.

Results: The median highest dose per patient was 256.8 Gy (195.7–807.8). Objective response at 3 months was 94.1% (complete 44.1% and partial 50%). Median OS was not reached and the 30-month OS rate was 59%, with a median follow-up of 13.4 months (5.4–39.4). FFP in the radiated field and overall FFP at 30 months were 67% and 40%, respectively. Favorable arterial supply was associated with improved OS (p = 0.018). Unfavorable arterial supply was associated with worse OS [HR 5.7 (95% CI 1.1–28.9, p = 0.034)], and PFS [HR 5.9 (95% CI 1.9–18.4, p = 0.002)]. Patients with mass-forming tumors had a survival benefit (p = 0.002). Laboratory values and performance status did not significantly change 3 months after radioembolization. Grade 3 and 4 adverse events occurred in 2 (7.1%) patients.

Conclusions: Radioembolization of unresectable intrahepatic cholangiocarcinoma with ablative intent has a high response rate, promising survival, and is well tolerated.

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