Trans-arterial chemoembolization and radioembolization for treatment of intrahepatic cholangiocarcinoma

Abstract

Trans-arterial therapies performed by interventional radiology, including chemoembolization and radioembolization, have been increasingly utilized for the treatment of unresectable intrahepatic cholangiocarcinoma. There is increasing evidence demonstrating the safety and efficacy of these interventions in patients with advanced disease. This review provides an overview of trans-arterial chemoembolization and radioembolization for unresectable intrahepatic cholangiocarcinoma, summarizes current evidence, and explores future directions for locoregional therapies.

Keywords

cholangiocarcinoma / TACE / TARE / radioembolization / Y90

References

[1] Bergquist A.Epidemiology of cholangiocarcinoma.Best Pract Res Clin Gastroenterol2015;29:221-32

[2] Andersen JB.Genetic profiling of intrahepatic cholangiocarcinoma.Curr Opin Gastroenterol2012;28:266-72 PMCID:PMC4017233

[3] Rizvi S.Pathogenesis, diagnosis, and management of cholangiocarcinoma.Gastroenterology2013;145:1215-29 PMCID:PMC3862291

[4] Saha SK,Fuchs CS.Forty-year trends in cholangiocarcinoma incidence in the U.S.: intrahepatic disease on the rise.Oncologist2016;21:594-9 PMCID:PMC4861366

[5] Shaib Y.The epidemiology of cholangiocarcinoma.Semin Liver Dis2004;24:115-25

[6] Sapisochin G,Lerut J.Liver transplantation for cholangiocarcinoma and mixed hepatocellular cholangiocarcinoma: working group report from the ILTS transplant oncology consensus conference.Transplantation2020;104:1125-30

[7] Hyder O,Sotiropoulos GC.Recurrence after operative management of intrahepatic cholangiocarcinoma.Surgery2013;153:811-8 PMCID:PMC3980567

[8] Mavros MN,Alexiou VG.Treatment and prognosis for patients with intrahepatic cholangiocarcinoma: systematic review and meta-analysis.JAMA Surg2014;149:565-74

[9] Valle J,Palmer DH.ABC-02 Trial InvestigatorsCisplatin plus gemcitabine versus gemcitabine for biliary tract cancer.N Engl J Med2010;362:1273-81

[10] Okusaka T,Fukutomi A.Gemcitabine alone or in combination with cisplatin in patients with biliary tract cancer: a comparative multicentre study in Japan.Br J Cancer2010;103:469-74 PMCID:PMC2939781

[11] Oh D,Qin S.A phase 3 randomized, double-blind, placebo-controlled study of durvalumab in combination with gemcitabine plus cisplatin (GemCis) in patients (pts) with advanced biliary tract cancer (BTC): TOPAZ-1.JCO2022;40:378

[12] Shroff RT,Xiao L.Gemcitabine, cisplatin, and nab-paclitaxel for the treatment of advanced biliary tract cancers: a phase 2 clinical trial.JAMA Oncol2019;5:824-30 PMCID:PMC6567834

[13] Zhu AX,Javle MM.Final overall survival efficacy results of ivosidenib for patients with advanced cholangiocarcinoma with IDH1 mutation: the phase 3 randomized clinical ClarIDHy trial.JAMA Oncol2021;7:1669-77

[14] Jain A,Kelley RK.Cholangiocarcinoma with FGFR genetic aberrations: a unique clinical phenotype.JCO Precis Oncol2018;2:1-12

[15] Goyal L,Hollebecque A.FOENIX-CCA2 Study InvestigatorsFutibatinib for FGFR2-Rearranged intrahepatic cholangiocarcinoma.N Engl J Med2023;388:228-39

[16] Kan Z.Liver anatomy: microcirculation of the liver.Semin Intervent Radiol2008;25:77-85 PMCID:PMC3036477

[17] Breedis C.The blood supply of neoplasms in the liver.Am J Pathol1954;30:969-77 PMCID:PMC1942491

[18] Tong AK,Too CW,Ng DC.Yttrium-90 hepatic radioembolization: clinical review and current techniques in interventional radiology and personalized dosimetry.Br J Radiol2016;89:20150943 PMCID:PMC5258157

[19] Ariel IM.Treatment of inoperable primary pancreatic and liver cancer by the intra-arterial administration of radioactive isotopes (Y90 radiating microspheres).Ann Surg1965;162:267-78 PMCID:PMC1476829

[20] Kennedy A,Salem R.Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium.Int J Radiat Oncol Biol Phys2007;68:13-23

[21] Lewandowski RJ,Liapi E.Transcatheter intraarterial therapies: rationale and overview.Radiology2011;259:641-57 PMCID:PMC3400295

[22] Leung WT,Ho SK.Measuring lung shunting in hepatocellular carcinoma with intrahepatic-arterial technetium-99m macroaggregated albumin.J Nucl Med1994;35:70-3.

[23] Leung TW,Ho SK.Radiation pneumonitis after selective internal radiation treatment with intraarterial 90yttrium-microspheres for inoperable hepatic tumors.Int J Radiat Oncol Biol Phys1995;33:919-24

[24] Collins J.Hepatic radioembolization complicated by gastrointestinal ulceration.Semin Intervent Radiol2011;28:240-5 PMCID:PMC3193333

[25] Estes DJ,Sendzischew Shane MA.Yttrium-90 radioembolization: an unusual cause of radiating abdominal pain.ACG Case Rep J2019;6:1-2 PMCID:PMC6658035

[26] Rafi S,El-Rayes B.Yttrium-90 radioembolization for unresectable standard-chemorefractory intrahepatic cholangiocarcinoma: survival, efficacy, and safety study.Cardiovasc Intervent Radiol2013;36:440-8

[27] Bourien H,Rolland Y.Yttrium-90 glass microspheres radioembolization (RE) for biliary tract cancer: a large single-center experience.Eur J Nucl Med Mol Imaging2019;46:669-76

[28] Saxena A,Chua TC,Morris DL.Yttrium-90 radiotherapy for unresectable intrahepatic cholangiocarcinoma: a preliminary assessment of this novel treatment option.Ann Surg Oncol2010;17:484-91

[29] Hoffmann RT,Schön A.Transarterial hepatic yttrium-90 radioembolization in patients with unresectable intrahepatic cholangiocarcinoma: factors associated with prolonged survival.Cardiovasc Intervent Radiol2012;35:105-16

[30] Buettner S,Margonis GA.Yttrium-90 radioembolization in intrahepatic cholangiocarcinoma: a multicenter retrospective analysis.J Vasc Interv Radiol2020;31:1035-43.e2

[31] Bargellini I,Pizzi G.Yttrium-90 radioembolization in unresectable intrahepatic cholangiocarcinoma: results of a multicenter retrospective study.Cardiovasc Intervent Radiol2020;43:1305-14

[32] Al-Adra DP,Axford SJ,Kneteman N.Treatment of unresectable intrahepatic cholangiocarcinoma with yttrium-90 radioembolization: a systematic review and pooled analysis.Eur J Surg Oncol2015;41:120-7 PMCID:PMC4316196

[33] Gangi A,Hatfield N.Intrahepatic cholangiocarcinoma treated with transarterial yttrium-90 glass microsphere radioembolization: results of a single institution retrospective study.J Vasc Interv Radiol2018;29:1101-8 PMCID:PMC7771272

[34] Mouli S,Baker T.Yttrium-90 radioembolization for intrahepatic cholangiocarcinoma: safety, response, and survival analysis.J Vasc Interv Radiol2013;24:1227-34 PMCID:PMC3800023

[35] Gupta AN,Gabr A.Yttrium-90 radioembolization of unresectable intrahepatic cholangiocarcinoma: long-term follow-up for a 136-patient cohort.Cardiovasc Intervent Radiol2022;45:1117-28

[36] Riaz A,Salem R.Side effects of yttrium-90 radioembolization.Front Oncol2014;4:198 PMCID:PMC4114299

[37] Sangro B,Bilbao JI.Radioembolization for hepatocellular carcinoma.J Hepatol2012;56:464-73

[38] Young JY,Atassi B.Radiation dose limits and liver toxicities resulting from multiple yttrium-90 radioembolization treatments for hepatocellular carcinoma.J Vasc Interv Radiol2007;18:1375-82

[39] Sangro B,Rodriguez J.Liver disease induced by radioembolization of liver tumors: description and possible risk factors.Cancer2008;112:1538-46

[40] Mosconi C,Vara G.Transarterial chemoembolization and radioembolization for unresectable intrahepatic cholangiocarcinoma-a systemic review and meta-analysis.Cardiovasc Intervent Radiol2021;44:728-38

[41] Gonsalves CF.Chemoembolization of hepatic malignancy.Abdom Imaging2009;34:557-65

[42] Gusani NJ,Steel JL.Treatment of unresectable cholangiocarcinoma with gemcitabine-based transcatheter arterial chemoembolization (TACE): a single-institution experience.J Gastrointest Surg2008;12:129-37

[43] Kiefer MV,McNally M.Chemoembolization of intrahepatic cholangiocarcinoma with cisplatinum, doxorubicin, mitomycin C, ethiodol, and polyvinyl alcohol: a 2-center study.Cancer2011;117:1498-505

[44] Lencioni R,Crocetti L.Chemoembolization of hepatocellular carcinoma.Semin Intervent Radiol2013;30:3-11 PMCID:PMC3700789

[45] Lencioni R,Burrel M.Transcatheter treatment of hepatocellular carcinoma with doxorubicin-loaded DC bead (DEBDOX): technical recommendations.Cardiovasc Intervent Radiol2012;35:980-5 PMCID:PMC3447142

[46] Venturini M,Agostini G.Chemoembolization with drug eluting beads preloaded with irinotecan (DEBIRI) vs doxorubicin (DEBDOX) as a second line treatment for liver metastases from cholangiocarcinoma: a preliminary study.Br J Radiol2016;89:20160247.

[47] Herber S,Schneider J.Transarterial chemoembolization (TACE) for inoperable intrahepatic cholangiocarcinoma.Cardiovasc Intervent Radiol2007;30:1156-65

[48] Vogl TJ,Nour-Eldin NE.Transarterial chemoembolization in the treatment of patients with unresectable cholangiocarcinoma: results and prognostic factors governing treatment success.Int J Cancer2012;131:733-40

[49] Ge Y,Luo GJ.Transarterial chemoembolization versus percutaneous microwave coagulation therapy for recurrent unresectable intrahepatic cholangiocarcinoma: development of a prognostic nomogram.Hepatobiliary Pancreat Dis Int2020;19:138-46

[50] Burger I,Schulick R.Transcatheter arterial chemoembolization in unresectable cholangiocarcinoma: initial experience in a single institution.J Vasc Interv Radiol2005;16:353-61

[51] Park SY,Yoon HJ,Yoon HK.Transarterial chemoembolization versus supportive therapy in the palliative treatment of unresectable intrahepatic cholangiocarcinoma.Clin Radiol2011;66:322-8

[52] Kim JH,Sung KB.Transcatheter arterial chemoembolization or chemoinfusion for unresectable intrahepatic cholangiocarcinoma: clinical efficacy and factors influencing outcomes.Cancer2008;113:1614-22

[53] Schiffman SC,Dubel G.Precision hepatic arterial irinotecan therapy in the treatment of unresectable intrahepatic cholangiocellular carcinoma: optimal tolerance and prolonged overall survival.Ann Surg Oncol2011;18:431-8

[54] Aliberti C,Tilli M.Chemoembolization (TACE) of unresectable intrahepatic cholangiocarcinoma with slow-release doxorubicin-eluting beads: preliminary results.Cardiovasc Intervent Radiol2008;31:883-8

[55] Liu D,Ma Z.Treatment of unresectable intrahepatic cholangiocarcinoma using transarterial chemoembolisation with irinotecan-eluting beads: analysis of efficacy and safety.Cardiovasc Intervent Radiol2022;45:1092-101

[56] Zhou TY,Zhang YL.Drug-eluting beads transarterial chemoembolization with CalliSpheres microspheres for treatment of unresectable intrahepatic cholangiocarcinoma.J Cancer2020;11:4534-41 PMCID:PMC7255354

[57] He M,Yin X,Mu K.Conventional and drug-eluting beads transarterial chemoembolization in patients with unresectable intrahepatic cholangiocarcinoma: a systematic review and pooled analysis.J Cancer Res Clin Oncol2023;149:531-40

[58] Wang J,Liu R.DEB-TACE with irinotecan versus C-TACE for unresectable intrahepatic cholangiocarcinoma: a prospective clinical study.Front Bioeng Biotechnol2022;10:1112500 PMCID:PMC9878160

[59] Scheuermann U,Heise M.Comparison of resection and transarterial chemoembolisation in the treatment of advanced intrahepatic cholangiocarcinoma--a single-center experience.Eur J Surg Oncol2013;39:593-600

[60] Lee DD,Musto KR.Liver transplantation for intrahepatic cholangiocarcinoma.Liver Transpl2018;24:634-44

[61] Pomoni M,Moschouris H.Post embolization syndrome in doxorubicin eluting chemoembolization with DC bead.Hepatogastroenterology2012;59:820-5

[62] Lencioni R,Soulen MC,Geschwind JF.Lipiodol transarterial chemoembolization for hepatocellular carcinoma: a systematic review of efficacy and safety data.Hepatology2016;64:106-16

[63] Clark TW.Complications of hepatic chemoembolization.Semin Intervent Radiol2006;23:119-25 PMCID:PMC3036366

[64] Tu J,Ying X.The incidence and outcome of major complication following conventional TAE/TACE for hepatocellular carcinoma.Medicine2016;95:e5606 PMCID:PMC5266057

[65] Lamarca A,Wasan HS.Second-line FOLFOX chemotherapy versus active symptom control for advanced biliary tract cancer (ABC-06): a phase 3, open-label, randomised, controlled trial.Lancet Oncol2021;22:690-701 PMCID:PMC8082275

[66] Gairing SJ,Müller L.The addition of transarterial chemoembolization to palliative chemotherapy extends survival in intrahepatic cholangiocarcinoma.J Clin Med2021;10:2732 PMCID:PMC8235389

[67] Martin RCG 2nd,Hansen P.Drug-eluting bead, irinotecan therapy of unresectable intrahepatic cholangiocarcinoma (DELTIC) with concomitant systemic gemcitabine and cisplatin.Ann Surg Oncol2022;29:5462-73

[68] Cucchetti A,Mosconi C.Improving patient selection for selective internal radiation therapy of intra-hepatic cholangiocarcinoma: a meta-regression study.Liver Int2017;37:1056-64

[69] Edeline J,Rayar M.Glass Microspheres 90Y selective internal radiation therapy and chemotherapy as first-line treatment of intrahepatic cholangiocarcinoma.Clin Nucl Med2015;40:851-5

[70] Edeline J,Guiu B.Radioembolization plus chemotherapy for first-line treatment of locally advanced intrahepatic cholangiocarcinoma: a phase 2 clinical trial.JAMA Oncol2020;6:51-9 PMCID:PMC6824230

[71] SIRT followed by CIS-GEM chemotherapy versus CIS-GEM chemotherapy alone as 1st line treatment of patients with unresectable intrahepatic cholangiocarcinoma (SIRCCA). Available from: https://clinicaltrials.gov/ct2/show/study/NCT02807181 [Last accessed on 27 Sep 2023]

[72] Akateh C,Pawlik TM.Neoadjuvant treatment strategies for intrahepatic cholangiocarcinoma.World J Hepatol2020;12:693-708 PMCID:PMC7643214

[73] Holster JJ,Franssen S.Hepatic arterial infusion pump chemotherapy for unresectable intrahepatic cholangiocarcinoma: a systematic review and meta-analysis.Ann Surg Oncol2022;29:5528-38 PMCID:PMC9356931

[74] Franssen S,Jolissaint JS.Comparison of hepatic arterial infusion pump chemotherapy vs resection for patients with multifocal intrahepatic cholangiocarcinoma.JAMA Surg2022;157:590-6 PMCID:PMC9096688

[75] Oh D,Qin S.Durvalumab plus gemcitabine and cisplatin in advanced biliary tract cancer.NEJM Evid2022;1

[76] Yang XG,Li DS,Huang XQ.Efficacy and safety of drug-eluting beads transarterial chemoembolization combining immune checkpoint inhibitors in unresectable intrahepatic cholangiocarcinoma: a propensity score matching analysis.Front Immunol2022;13:940009 PMCID:PMC9305385