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

Area of Science:

• Hepatobiliary Oncology
• Interventional Radiology
• Nuclear Medicine

Background:

• Intrahepatic cholangiocarcinoma (iCCA) is an aggressive liver cancer with few non-surgical treatment options.
• Transarterial radioembolization (TARE) has historically been a palliative treatment for iCCA.

Purpose of the Study:

• To review the evolution of TARE for iCCA from palliative to curative-intent therapy.
• To highlight advances in TARE techniques and dosimetry for iCCA management.

Main Methods:

• Review of studies on TARE with Yttrium-90 microspheres for iCCA.
• Analysis of outcomes based on dosimetry models, combination therapies, and specific TARE techniques (e.g., radiation segmentectomy, bridging to transplant).

Main Results:

• Partition-model dosimetry shows superior survival (14.9 vs. 5.5 months) compared to empiric approaches.
• Multimodal TARE with systemic therapy yields median overall survival of 32.5 months, with high response rates (39-85%) and downstaging for resection (22-54%).
• Ablative radiation segmentectomy achieves 94% response rates and up to 72 months median survival in early-stage disease; TARE as a bridge to transplant results in 5-year survival of 57%.

Conclusions:

• Contemporary TARE, particularly with personalized dosimetry (≥205 Gy to tumor), represents a transformative liver-directed therapy for selected iCCA patients.
• Optimal outcomes are associated with tumor burden <25%, preserved liver function, and good performance status.
• TARE is increasingly utilized as a curative-intent strategy, including in first-line settings and as a bridge to transplantation.