Yttrium-90 Transarterial Radioembolization for Intrahepatic Cholangiocarcinoma: A Comprehensive Review

Intrahepatic cholangiocarcinoma (iCCA) represents an aggressive primary hepatic malignancy with limited non-surgical therapeutic options. This review examines the evolution of transarterial radioembolization (TARE) with Yttrium-90 microspheres from palliative intervention to curative-intent therapy, driven by advances over the past few decades. Partition-model dosimetry demonstrates superior survival compared to empiric approaches (14.9 versus 5.5 months, P < 0.001), establishing the critical importance of individualized treatment planning. In first-line settings, multimodal strategies combining TARE with systemic therapy achieve median overall survival of 32.5 months, with intensive protocols demonstrating objective response rates of 39-85% and downstaging to curative resection in 22-54% of patients. Ablative radiation segmentectomy delivers tumor doses exceeding 190 Gy, achieving objective response rates of 94%, median survival of up to 72 months in early-stage disease. TARE-based bridging to liver transplantation yields 5-year survival of 57% from time of transplant listing. Optimal outcomes are observed for tumor burden below 25%, preserved hepatic function, favorable performance status, and personalized dosimetry delivering ≥205 Gy to tumor. Contemporary TARE represents a transformative paradigm in liver-directed therapy for appropriately selected iCCA patients.