Radioembolization with Yttrium-90 Glass Microspheres as a First-Line Treatment for Unresectable Intrahepatic Cholangiocarcinoma-A Prospective Feasibility Study

J Vasc Interv Radiol. 2023 Sep;34(9):1547-1555. doi: 10.1016/j.jvir.2023.05.026. Epub 2023 May 18.


Purpose: To evaluate the safety and effectiveness of yttrium-90 (90Y) radioembolization as first-line treatment for unresectable intrahepatic cholangiocarcinoma (ICC).

Materials and methods: This prospective study enrolled patients who had never received chemotherapy, liver embolization, and radiation therapy. The tumors were solitary in 16 patients, multiple in 8 patients, unilobar in 14 patients, and bilobar in 10 patients. Patients underwent transarterial radioembolization with 90Y-labeled glass microspheres. The primary end point was hepatic progression-free survival (HPFS). Secondary end points were overall survival (OS), tumor response, and toxicity.

Results: Twenty-four patients (age, 72.3 years ± 9.3; 12 women) were included in the study. The median delivered radiation dose was 135.5 Gy (interquartile range, 77.6 Gy). The median HPFS was 5.5 months (95% CI, 3.9-7.0 months). Analysis failed to identify any prognostic factor associated with HPFS. Imaging response at 3 months showed 56% disease control, and the best radiographic response was 71% disease control. The median OS from the radioembolization treatment was 19.4 months (95% CI, 5.0-33.7). Patients with solitary ICC had significantly longer median OS than patients with multifocal ICC: 25.9 months (95% CI, 20.8-31.0 months) versus 10.7 months (95% CI, 8.0-13.4 months) (P = .02). Patients with progression on the 3-month imaging follow-up had significantly shorter median OS than patients who had stable disease at 3 months: 10.7 months (95% CI, 0.7-20.7 months) versus 37.3 months (95% CI, 16.5-58.1 months) (P = .003). Two (8%) Grade 3 toxicities were reported.

Conclusions: First-line treatment of ICC with radioembolization showed promising OS and minimal toxicity, especially in patients with solitary tumor. Radioembolization may be considered as a first-line treatment option for unresectable ICC.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Bile Duct Neoplasms* / diagnostic imaging
  • Bile Duct Neoplasms* / radiotherapy
  • Bile Ducts, Intrahepatic
  • Cholangiocarcinoma* / diagnostic imaging
  • Cholangiocarcinoma* / radiotherapy
  • Embolization, Therapeutic* / methods
  • Feasibility Studies
  • Female
  • Humans
  • Liver Neoplasms* / diagnostic imaging
  • Liver Neoplasms* / radiotherapy
  • Microspheres
  • Prospective Studies
  • Treatment Outcome
  • Yttrium Radioisotopes


  • Yttrium-90
  • Yttrium Radioisotopes