Radioembolization vs. chemoembolization for the treatment of intrahepatic cholangiocarcinoma: an observational comparative study

The treatment of intrahepatic cholangiocarcinoma is challenging. Surgery is effective for limited disease, but for those with extensive disease or those who are not surgical candidates, systemic chemotherapy is the standard. Patients invariably fail systemic chemotherapy, leaving few options for disease control. Radioembolization (90Y) and chemoembolization (CE) may be of benefit, but there is sparse data on their relative performance. We aim to compare the relative toxicity and efficacy of both treatments. An Institutional Review Board-approved, retrospective search was performed from 2001 to 2016. There were 40 consecutive patients with intrahepatic cholangiocarcinoma treated with either 90Y (n = 25, 39 treatments) or CE (n = 15, 35 treatments). Comparative analysis was performed using Student’s-t and Fisher exact tests. Contingency test followed by logistic regression was performed to determine correlation between patient variables and hepatic disease control rate (HDCR). Median ages were 60 and 64 years for the CE and 90Y groups, respectively (p = 0.798). The 90Y group had higher baseline ECOG scores (p = 0.007) and lower overall tumor burden (p = 0.03). Other patient variables, including gender, extrahepatic disease, prior chemotherapy, concomitant chemotherapy, prior liver surgery or ablation, were similar. Most were lobar treatments with a median of 2 treatments per subject. All-grade adverse events were similar in both groups (CE 20%, 90Y 26%; p>0.9). High-grade adverse events were also similar. Hepatic response rate (CE 6%, 90Y 4%; p>0.9) and HDCR (CE 46%, 90Y 48%; p>0.9) were statistically similar. Multi-logistic regression did not identify any variables that correlated with HDCR, including ECOG score and tumor burden. No difference in the rate of surgical downstaging. Our observation suggests that CE and 90Y display similar toxicity and efficacy in the treatment of intrahepatic cholangiocarcinoma. Given the favorable HDCR in this pretreated population, CE and 90Y may benefit this patient population.