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Updated: Jul 3, 2026
Y-90 Radioembolization and PD-1 Inhibitor as Neoadjuvant Treatment in Hepatocellular Carcinoma
Published on: May 24, 2024
Intrahepatic cholangiocarcinoma treated with glass yttrium-90 radioembolization: A histopathologic study
Qian Yu1, Peizi Li2, Satvik Jain3
1Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, IL, 60637, USA. yuqian1006@gmail.com.
Purpose:
To determine the degree of tumor necrosis on pathology and clinical outcomes among intrahepatic cholangiocarcinoma (iCCA) patients who were treated with transarterial radioembolization (TARE) and the bridge or downstaged to surgery.
Methods:
A single center retrospective review was performed to include consecutive patients who underwent TARE using glass microspheres and then subsequently underwent surgical resection or transplant. Baseline characteristics, dosimetry, radiologic response, histological tumor necrosis, and overall survival were evaluated. A total of 20 patients (F: M = 14:6; age: 57.3 ± 10.8 years) underwent TARE and then received resection (n = 15) or living-donor liver transplant (n = 5). A total of 23 selective TARE (two segments or less) were delivered, with a mean dose 301.7 ± 177.5, whereas 18 lobar (left or right hepatic artery) doses were delivered, with a mean dose of 150.3 ± 44.1 Gy. Concurrent systemic therapy was administered in 15 patients.
Results:
The mean time from the initial TARE to surgery was 7.1 ± 9.2 months. On pathology, complete tumor necrosis, > 90% necrosis, and extensive tumor necrosis (> 50%) were achieved in 1 (5.0%), 13 (65.0%), and 18 (90.0%) patients, respectively. The median survival time (MST) calculated from the time of surgery was 40.2 (95%CI: 15.3-not reached) months, with a 1-yr, 3-yr, and 5-yr OS of 88.2% (95CI: 60.6-96.9%), 57.8% (95%CI: 31.1-77.3%), and 19.8% (95%CI: 1.5-53.5%). From the time of initial TARE, the MST was 41.4 (95%CI:22.9-not reached) month, with a 1-yr, 3-yr, and 5-yr OS of 100%, 69.9% (95%CI: 42.0-86.3%), and 30.9% (95%CI: 9.1-56.3%). Whether the patient received concomitant systemic treatment was associated with extensive tumor necrosis on pathology (Odds Ratio: 16.0, 95%CI: 1.27-200.92, p = 0.032).
Conclusion:
Based on tumor explant data, TARE can result in substantial tumor necrosis in the treatment of iCCA, although complete necrosis is uncommon. The addition of systemic therapy appears to be associated with a higher likelihood of achieving extensive tumor necrosis.
