Radioembolization with 90Y resin microspheres for intrahepatic cholangiocellular carcinoma: prognostic factors

Aim To investigate the prognostic factors that predict overall survival after radioembolization in patients with cholangiocellular carcinoma. Methods The study comprised 16 patients who received radioembolization with Y-90 resin microspheres for cholangiocarcinoma. The statistical relationships between overall survival after radioembolization and age, number, dimension and fluorodeoxyglucose (FDG) avidity of liver lesions, liver tumor load, presence of extrahepatic metastases, and radiological response were analyzed. Results Mean 1.7 +/- 0.1 GBq(90)Y microspheres were administered to a total of 16 patients (mean age: 55.37 +/- 17.7; 8 males, 8 females). Mean AST, ALT, and total bilirubin levels were calculated as 35 +/- 15, 40 +/- 37 IU/L, and 0.77 +/- 0.37 mG/dL, respectively. In 6 patients, 1 liver lesion was determined, in 2 patients <= 5, and in 8 patients >5, with dimensions varying between 12 and 120 mm. The liver lesions of 13 patients were FDG avid (mean SUVmax: 7.4 +/- 2.2). Extrahepatic metastases were demonstrated in 5 patients. Tumor load of 4, 8, and 4 patients was calculated as <25, 25-50, and >50 %, respectively. Five patients were responsive to treatment. During the follow-up period of 243 (range 98-839) days, 12 patients died. In Cox-regression analysis, FDG avidity (p = 0.02), the dimensions (p = 0.03) of the liver lesion, tumor load (p = 0.02), and radiological response (p = 0.01) were found to be statistically significant parameters predictive of overall survival after radioembolization (p = 0.006). Conclusion FDG avidity and the dimension of the largest liver lesion, tumor load, and radiological response are prognostic factors in patients receiving radioembolization for cholangiocellular carcinoma. Patients with lower tumor load, FDG-negative tumors, and smaller tumors seem to survive longer after radioembolization.