Any role for transarterial radioembolization in unresectable intrahepatic cholangiocarcinoma in the era of advanced systemic therapies?

Table 1 Characteristics of the included studies evaluating transarterial radioembolization in intrahepatic cholangiocarcinoma

Ref.	Study design	N patients	Inclusion criteria	Technique	Median OS (mo)	R-response (%)
Ibrahim et al[26], 2008	Report	24	Histological diagnosis; Unresectable disease; ECOG ≤ 2; Neutrophil > 1.5 × 109/L; Platelet > 50 × 109/L; Creatinine < 2.0 mg/dL; Bilirubin < 2.0 mg/dL; Able to undergo angiography	90Yttrium (90Y); Radioembolization	14	86
Boehm et al[24], 2015	Systematic Review and Metanalysis	127	Unresectable disease; TARE treatment	90Yttrium (90Y); Radioembolization	13.9	27.4 (partial or complete; 54 (stable disease)
Gangi et al[15], 2018	Single Center; Retrospective study	85	Histological diagnosis; Unresectable disease; ECOG ≤ 2; Platelet > 50 × 109/L; Creatinine ≤ 2.0 mg/dL; Bilirubin ≤ 2.0 mg/dL; INR ≤ 1.5	90Yttrium (90Y); Radioembolization	12	6.2 (partial response); 64 (stable disease)
Pellegrinelli et al[27], 2021	Single center; Retrospective study	6	Unresectable disease; ECOG ≤ 2; Platelet > 50 × 109/L; Bilirubin < 2.0 mg/dL; Prothrombin time > 50%; Able to undergo angiography	90Yttrium (90Y); Radioembolization	16	NA
Robinson et al[14], 2022	Registry data	95	NA		14	34
Edeline et al[28], 2020	Phase 2; Clinical Trial	41	Unresectable disease; Never received CT; Never received intra-arterial treatment	90Yttrium (90Y); Radioembolization + Cisplatin and Gemcitabine	22	39
Fleckenstein et al[29], 2022	Single center; Retrospective study	9	Unresectable disease; At least one TARE treatment; At least one CT-HDRBT treatment	90Yttrium (90Y); Radioembolization + CT-HDRBT	29	NA

NA: Not available; CT: Computed tomography; CT-HDRBT: CT-guided high-dose-rate interstitial brachytherapy; R-response: Radiologic response; ECOG: Eastern Cooperation Oncology Group; OS: Overall survival; TARE: Transarterial radioembolization; INR: International normalized ratio.

Table 2 Transarterial radioembolization induced toxicities

Paper	Mild to moderate (grade 1-2)		Severe (grade 3-4)
	Biochemical (%)	Constitutional (%)	Biochemical (%)	Constitutional (%)
Ibrahim et al[26], 2008	-	Fatigue (75); Abdominal pain (38); vomiting (13); anorexia (8)	Albumin (17); Bilirubin (4)	Gastroduodenal Ulcer (4); Ascites (14); Pleural effusion (9)
Gangi et al[15], 2018	(53)	Fatigue (42.3); Abdominal Pain (18.8); Weight loss (7.1); Ascites (5.9)	Bilirubin and Alkaline phosphatase elevation (9)	Liver abscess (2)
Pellegrinelli et al[27], 2021	-	-	-	Cholecystitis and angiocholitis (2.85)
Robinson et al[14], 2022	-	-	Bilirubin (10.5), Albumin (2.6), AST increase (7.8), ALT increase (5.2)	Abdominal pain, Cholecystitis (4.1)

AST: Aspartate transaminase; ALT: Alanine transaminase.