Treatment of unresectable cholangiocarcinoma using yttrium-90 microspheres: Results from a pilot study

Saad M. Ibrahim, Mary Frances Mulcahy, Robert J Lewandowski, Kent T Sato, Robert K. Ryu, Elizabeth J. Masterson, Steven B. Newman, Al B Benson III, Reed A. Omary, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

123 Citations (Scopus)

Abstract

BACKGROUND. The objective of this report was to present data from an open-label cohort study in which patients with intrahepatic cholangiocarcinoma (ICC) underwent radioembolization with yttrium-90 (90Y) microspheres. METHODS. Twenty-four patients with histologically proven ICC were treated. The planned target dose was 120 Gray. Patients were stratified according to Eastern Cooperation Oncology Group (ECOG) performance status, tumor morphology (infiltrative vs peripheral), tumor distribution (solitary vs multifocal), and the presence or absence of portal vein thrombosis (PVT). Before and after the procedure, the following variables were assessed: 1) biochemical and clinical toxicity, 2) imaging (computed tomography/magnetic resonance imaging) response according to World Health Organization and European Association for the Study of Liver Disease (EASL) criteria, and 3) median survival after the first treatment using Kaplan-Meier methodology. RESULTS. In total, 48 90Y treatments were administered to hepatic segments or lobes. Fatigue and transient abdominal pain were reported in 18 patients (75%) and 10 patients (42%), respectively. One patient (4%) developed grade 3 bilirubin toxicity. One patient (4%) developed a treatment-related gastroduodenal ulcer. On imaging follow-up of 22 patients, tumors demonstrated a partial response in 6 patients (27%), stable disease in 15 patients (68%), and progressive disease in 1 patient (5%). By using EASL guidelines, 17 patients (77%) showed >50% tumor necrosis on imaging follow-up. Two patients (9%) demonstrated 100% tumor necrosis. The median overall survival for the entire cohort (n = 24) was 14.9 months. The median survival for patients with an ECOG performance status of 0, 1, and 2 was 31.8 months, 6.1 months, and 1 month, respectively (P < .0001); the median survival for patients without and with PVT was 31.8 months and 5.7 months, respectively (P = .0003); and the median survival for patients with peripheral versus periductal-infiltrative tumors was 31.8 months and 5.7 months, respectively (P = .0005). CONCLUSIONS. Radioembolization with 90Y may be a therapeutic option for the treatment of unresectable ICC.

Original languageEnglish (US)
Pages (from-to)2119-2128
Number of pages10
JournalCancer
Volume113
Issue number8
DOIs
StatePublished - Oct 15 2008

Fingerprint

Yttrium
Cholangiocarcinoma
Microspheres
Therapeutics
Survival
Neoplasms
Portal Vein
Liver Diseases
Thrombosis
Necrosis

Keywords

  • Brachytherapy
  • Radioembolization
  • SIRSpheres
  • Selective internal radiation
  • TheraSphere
  • Yttrium-90 microspheres

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Ibrahim, Saad M. ; Mulcahy, Mary Frances ; Lewandowski, Robert J ; Sato, Kent T ; Ryu, Robert K. ; Masterson, Elizabeth J. ; Newman, Steven B. ; Benson III, Al B ; Omary, Reed A. ; Salem, Riad. / Treatment of unresectable cholangiocarcinoma using yttrium-90 microspheres : Results from a pilot study. In: Cancer. 2008 ; Vol. 113, No. 8. pp. 2119-2128.
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title = "Treatment of unresectable cholangiocarcinoma using yttrium-90 microspheres: Results from a pilot study",
abstract = "BACKGROUND. The objective of this report was to present data from an open-label cohort study in which patients with intrahepatic cholangiocarcinoma (ICC) underwent radioembolization with yttrium-90 (90Y) microspheres. METHODS. Twenty-four patients with histologically proven ICC were treated. The planned target dose was 120 Gray. Patients were stratified according to Eastern Cooperation Oncology Group (ECOG) performance status, tumor morphology (infiltrative vs peripheral), tumor distribution (solitary vs multifocal), and the presence or absence of portal vein thrombosis (PVT). Before and after the procedure, the following variables were assessed: 1) biochemical and clinical toxicity, 2) imaging (computed tomography/magnetic resonance imaging) response according to World Health Organization and European Association for the Study of Liver Disease (EASL) criteria, and 3) median survival after the first treatment using Kaplan-Meier methodology. RESULTS. In total, 48 90Y treatments were administered to hepatic segments or lobes. Fatigue and transient abdominal pain were reported in 18 patients (75{\%}) and 10 patients (42{\%}), respectively. One patient (4{\%}) developed grade 3 bilirubin toxicity. One patient (4{\%}) developed a treatment-related gastroduodenal ulcer. On imaging follow-up of 22 patients, tumors demonstrated a partial response in 6 patients (27{\%}), stable disease in 15 patients (68{\%}), and progressive disease in 1 patient (5{\%}). By using EASL guidelines, 17 patients (77{\%}) showed >50{\%} tumor necrosis on imaging follow-up. Two patients (9{\%}) demonstrated 100{\%} tumor necrosis. The median overall survival for the entire cohort (n = 24) was 14.9 months. The median survival for patients with an ECOG performance status of 0, 1, and 2 was 31.8 months, 6.1 months, and 1 month, respectively (P < .0001); the median survival for patients without and with PVT was 31.8 months and 5.7 months, respectively (P = .0003); and the median survival for patients with peripheral versus periductal-infiltrative tumors was 31.8 months and 5.7 months, respectively (P = .0005). CONCLUSIONS. Radioembolization with 90Y may be a therapeutic option for the treatment of unresectable ICC.",
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Treatment of unresectable cholangiocarcinoma using yttrium-90 microspheres : Results from a pilot study. / Ibrahim, Saad M.; Mulcahy, Mary Frances; Lewandowski, Robert J; Sato, Kent T; Ryu, Robert K.; Masterson, Elizabeth J.; Newman, Steven B.; Benson III, Al B; Omary, Reed A.; Salem, Riad.

In: Cancer, Vol. 113, No. 8, 15.10.2008, p. 2119-2128.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Treatment of unresectable cholangiocarcinoma using yttrium-90 microspheres

T2 - Results from a pilot study

AU - Ibrahim, Saad M.

AU - Mulcahy, Mary Frances

AU - Lewandowski, Robert J

AU - Sato, Kent T

AU - Ryu, Robert K.

AU - Masterson, Elizabeth J.

AU - Newman, Steven B.

AU - Benson III, Al B

AU - Omary, Reed A.

AU - Salem, Riad

PY - 2008/10/15

Y1 - 2008/10/15

N2 - BACKGROUND. The objective of this report was to present data from an open-label cohort study in which patients with intrahepatic cholangiocarcinoma (ICC) underwent radioembolization with yttrium-90 (90Y) microspheres. METHODS. Twenty-four patients with histologically proven ICC were treated. The planned target dose was 120 Gray. Patients were stratified according to Eastern Cooperation Oncology Group (ECOG) performance status, tumor morphology (infiltrative vs peripheral), tumor distribution (solitary vs multifocal), and the presence or absence of portal vein thrombosis (PVT). Before and after the procedure, the following variables were assessed: 1) biochemical and clinical toxicity, 2) imaging (computed tomography/magnetic resonance imaging) response according to World Health Organization and European Association for the Study of Liver Disease (EASL) criteria, and 3) median survival after the first treatment using Kaplan-Meier methodology. RESULTS. In total, 48 90Y treatments were administered to hepatic segments or lobes. Fatigue and transient abdominal pain were reported in 18 patients (75%) and 10 patients (42%), respectively. One patient (4%) developed grade 3 bilirubin toxicity. One patient (4%) developed a treatment-related gastroduodenal ulcer. On imaging follow-up of 22 patients, tumors demonstrated a partial response in 6 patients (27%), stable disease in 15 patients (68%), and progressive disease in 1 patient (5%). By using EASL guidelines, 17 patients (77%) showed >50% tumor necrosis on imaging follow-up. Two patients (9%) demonstrated 100% tumor necrosis. The median overall survival for the entire cohort (n = 24) was 14.9 months. The median survival for patients with an ECOG performance status of 0, 1, and 2 was 31.8 months, 6.1 months, and 1 month, respectively (P < .0001); the median survival for patients without and with PVT was 31.8 months and 5.7 months, respectively (P = .0003); and the median survival for patients with peripheral versus periductal-infiltrative tumors was 31.8 months and 5.7 months, respectively (P = .0005). CONCLUSIONS. Radioembolization with 90Y may be a therapeutic option for the treatment of unresectable ICC.

AB - BACKGROUND. The objective of this report was to present data from an open-label cohort study in which patients with intrahepatic cholangiocarcinoma (ICC) underwent radioembolization with yttrium-90 (90Y) microspheres. METHODS. Twenty-four patients with histologically proven ICC were treated. The planned target dose was 120 Gray. Patients were stratified according to Eastern Cooperation Oncology Group (ECOG) performance status, tumor morphology (infiltrative vs peripheral), tumor distribution (solitary vs multifocal), and the presence or absence of portal vein thrombosis (PVT). Before and after the procedure, the following variables were assessed: 1) biochemical and clinical toxicity, 2) imaging (computed tomography/magnetic resonance imaging) response according to World Health Organization and European Association for the Study of Liver Disease (EASL) criteria, and 3) median survival after the first treatment using Kaplan-Meier methodology. RESULTS. In total, 48 90Y treatments were administered to hepatic segments or lobes. Fatigue and transient abdominal pain were reported in 18 patients (75%) and 10 patients (42%), respectively. One patient (4%) developed grade 3 bilirubin toxicity. One patient (4%) developed a treatment-related gastroduodenal ulcer. On imaging follow-up of 22 patients, tumors demonstrated a partial response in 6 patients (27%), stable disease in 15 patients (68%), and progressive disease in 1 patient (5%). By using EASL guidelines, 17 patients (77%) showed >50% tumor necrosis on imaging follow-up. Two patients (9%) demonstrated 100% tumor necrosis. The median overall survival for the entire cohort (n = 24) was 14.9 months. The median survival for patients with an ECOG performance status of 0, 1, and 2 was 31.8 months, 6.1 months, and 1 month, respectively (P < .0001); the median survival for patients without and with PVT was 31.8 months and 5.7 months, respectively (P = .0003); and the median survival for patients with peripheral versus periductal-infiltrative tumors was 31.8 months and 5.7 months, respectively (P = .0005). CONCLUSIONS. Radioembolization with 90Y may be a therapeutic option for the treatment of unresectable ICC.

KW - Brachytherapy

KW - Radioembolization

KW - SIRSpheres

KW - Selective internal radiation

KW - TheraSphere

KW - Yttrium-90 microspheres

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