There is one important aspect that needs to be added to this concise and noteworthy review (1) of the diagnosis and treatment of cholangiocarcinoma: Radioembolization is a clinically relevant treatment option in palliative patients after failure of systemic first-line therapy (gemcitabine + cisplatin), even though it is not yet supported by strong evidence.
This method, also known as SIRT (selective internal radiation therapy), represents a locoregional transarterial therapy with Y-90 microspheres causing semi-selective internal radiation of the hepatic tumor lesions after intra-arterial application and preferential deposition within the tumor. Prerequisites include arterial (hyper-) perfusion and good angiographic accessibility of the cholangiocarcinoma lesions. Neither tumor size, number of lesions or proximity to vessels, nor portal vein infiltration or thrombosis are limitations or contraindications to its use.
Radioembolization can achieve dramatic remissions with high rates of local tumor control through tumor-absorbed doses of in the order of1000+ Gy (2). For its indication, there are specific requirements with regard to the liver reserve, the general condition (ECOG ≤ 2) as well as liver-dominant total tumor burden, apart from the above mentioned technical prerequisites.
Several studies have documented disease-control rates of 74 to 98% and median survival rates (OS) of 9 to 22 months (3, 4).
It is important to raise awareness of this method because the reader of this review may not consider this option for an eligible palliative patient after failure of the standard chemotherapy regimen. However, this treatment modality may provide tumor control over a period of more than one year with good quality of life to suitable patients. An individual assessment of this option should therefore be mentioned as an alternative to therapeutic nihilism.
Footnotes
Conflict of interest statement
Prof. Ezziddin has received fees for the preparation of scientific presentations further education events from SIRTex and Nordion.
Prof. Brückner and Prof. Lammert declare that no conflict of interest exists.
References
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