Potential Benefits of Holmium-166 Radioembolization as a Neoadjuvant Treatment of Intrahepatic Cholangiocarcinoma
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LETTER TO THE EDITOR
INTERVENTIONAL ONCOLOGY
Potential Benefits of Holmium-166 Radioembolization as a Neoadjuvant Treatment of Intrahepatic Cholangiocarcinoma Tommaso Depalo1 • Giuseppe Boni1 • Davide Ghinolfi2 • Elena Bozzi3 • Rosa Cervelli3 • Gabriele Catalano2 • Duccio Volterrani1 • Irene Bargellini3
Received: 1 July 2020 / Accepted: 23 July 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Dear Editor, We wish to report the potential benefits of radioembolization (RE) with poly-L-lactic acid (PLLA) microspheres (QuiremSpheresÒ, Quirem Medical, Deventer, the Netherlands) as neoadjuvant treatment of initially inoperable intrahepatic cholangiocarcinoma (ICC). Several patients are considered unresectable at diagnosis because of the tumor extension that would lead to a small future liver remnant (FLR) after resection. RE may offer the advantage of inducing hypertrophy of the contralateral
& Tommaso Depalo [email protected] Giuseppe Boni [email protected] Davide Ghinolfi [email protected] Elena Bozzi [email protected] Rosa Cervelli [email protected] Gabriele Catalano [email protected] Duccio Volterrani [email protected] Irene Bargellini [email protected] 1
Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy
2
Division of Hepatic Surgery and Liver Transplantation, University Hospital of Pisa, Pisa, Italy
3
Department of Vascular and Interventional Radiology, University Hospital of Pisa, Pisa, Italy
untreated liver lobe, while treating the tumor, thus allowing resection [1]. A recent phase 2 study showed that out of 41 ICC patients treated with a combination of systemic therapy and RE using Yttrium-90 (90Y) particles, nine patients were downstaged to resection resulting in a postsurgical 24-month overall survival rate of 88.9% [2]. However, the positive effects of 90Y-RE may take several months to occur during which the tumor may progress with new intraand extra-hepatic lesions that would exclude patients from surgery [3]. The recently introduced PLLA microspheres contain Holmium-166 (166Ho) that is b-emitter with a shorter halflife (26.8 h) compared to 90Y (64 h), resulting in a faster deposition (4 vs. 11 days) of 90% of the radiation dose in the tumor tissue [4]. Moreover, 166Ho is a c-emitting radionuclide that can be imaged with SPECT/CT, not only after therapy but also after injection of a diagnostic activity (so-called 166Ho-Scout Dose; 166Ho-SD); this could replace the conventional 99mTc-labeled macroaggregated albumin (MAA) scintigraphy, as a more reproducible preprocedural planning modality for RE [5]. A 69-year-old female, affected by a 73-mm single and centrally located ICC lesion, surrounding the partially thrombosed anterior branches of the right portal vein and the inferior vena cava, was considered unfit for surgery and started a first-line chemotherapy based on a cisplatin– gemcitabine regimen. At 6 mont
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