Segmental Yttrium-90 Radioembolization using Glass Microspheres Greater than 400 Gray for the Treatment of Intrahepatic Cholangiocarcinoma: A Preliminary Experience.

Radiation segmentectomy dosed >190 Gy using yttrium-90 (Y-90) glass microspheres for intrahepatic cholangiocarcinoma (iCCA) has been shown safe and effective. The present study further increased dosing to >400Gy for treatment of iCCA, as complete pathological necrosis has been shown in hepatocellular carcinoma using this ablative approach. A total of 10 patients with 13 tumors (median size 5.3 cm, range 1.5-13.6 cm) at a single institution underwent >400 Gy segmental radioembolization. Objective response was achieved in all tumors (13/13, 100%). One patient developed a grade 3 or greater major adverse event (stroke and hepatic decompensation). One patient was bridged to transplant (>95% pathologic necrosis), whereas another underwent resection (>99% necrosis). Contralateral hypertrophy was observed in 6/6 patients treated with modified lobectomy dosing with a functional liver reserve increase from median of 31.5% to 57.1%. The present report suggests that segmental TARE with greater than 400Gy is feasible in terms of safety and effectiveness in iCCA.