Semin intervent Radiol 2020; 37(05): 475-483
DOI: 10.1055/s-0040-1719188
Review Article

Intrahepatic Cholangiocarcinoma

Pouya Entezari
1   Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
,
Ahsun Riaz
1   Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
› Author Affiliations

Abstract

Cholangiocarcinoma is the second most common primary malignancy of the liver. This review will focus on the mass-forming intrahepatic type of this disease and discuss the role of medical, surgical, and radiation oncology in managing this difficult disease. A global understanding to the management of intrahepatic cholangiocarcinoma (ICC) can help the interventional radiologist understand the role of locoregional therapies such as ablation, transarterial chemoembolization, and radioembolization in the management of ICC.



Publication History

Article published online:
11 December 2020

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  • References

  • 1 Ghouri YA, Mian I, Blechacz B. Cancer review: cholangiocarcinoma. J Carcinog 2015; 14: 1
  • 2 Shaib Y, El-Serag HB. The epidemiology of cholangiocarcinoma. Semin Liver Dis 2004; 24 (02) 115-125
  • 3 Poultsides GA, Zhu AX, Choti MA, Pawlik TM. Intrahepatic cholangiocarcinoma. Surg Clin North Am 2010; 90 (04) 817-837
  • 4 Brandi G, Venturi M, Pantaleo MA, Ercolani G. GICO. Cholangiocarcinoma: Current opinion on clinical practice diagnostic and therapeutic algorithms: a review of the literature and a long-standing experience of a referral center. Dig Liver Dis 2016; 48 (03) 231-241
  • 5 Blechacz B, Komuta M, Roskams T, Gores GJ. Clinical diagnosis and staging of cholangiocarcinoma. Nat Rev Gastroenterol Hepatol 2011; 8 (09) 512-522
  • 6 Guglielmi A, Ruzzenente A, Campagnaro T. et al. Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg 2009; 33 (06) 1247-1254
  • 7 Endo I, Gonen M, Yopp AC. et al. Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg 2008; 248 (01) 84-96
  • 8 Khan SA, Toledano MB, Taylor-Robinson SD. Epidemiology, risk factors, and pathogenesis of cholangiocarcinoma. HPB (Oxford) 2008; 10 (02) 77-82
  • 9 Patel T. Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States. Hepatology 2001; 33 (06) 1353-1357
  • 10 Shaib YH, Davila JA, McGlynn K, El-Serag HB. Rising incidence of intrahepatic cholangiocarcinoma in the United States: a true increase?. J Hepatol 2004; 40 (03) 472-477
  • 11 Hamilton SR, Aaltonen LA. Pathology and Genetics of Tumours of the Digestive System. Vol 2. Lyon, France: IARC Press; 2000
  • 12 Palmer WC, Patel T. Are common factors involved in the pathogenesis of primary liver cancers? A meta-analysis of risk factors for intrahepatic cholangiocarcinoma. J Hepatol 2012; 57 (01) 69-76
  • 13 Shaib YH, El-Serag HB, Davila JA, Morgan R, McGlynn KA. Risk factors of intrahepatic cholangiocarcinoma in the United States: a case-control study. Gastroenterology 2005; 128 (03) 620-626
  • 14 Bridgewater J, Galle PR, Khan SA. et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol 2014; 60 (06) 1268-1289
  • 15 Rimola J, Forner A, Reig M. et al. Cholangiocarcinoma in cirrhosis: absence of contrast washout in delayed phases by magnetic resonance imaging avoids misdiagnosis of hepatocellular carcinoma. Hepatology 2009; 50 (03) 791-798
  • 16 Vilana R, Forner A, Bianchi L. et al. Intrahepatic peripheral cholangiocarcinoma in cirrhosis patients may display a vascular pattern similar to hepatocellular carcinoma on contrast-enhanced ultrasound. Hepatology 2010; 51 (06) 2020-2029
  • 17 Jarnagin WR, Shoup M. Surgical management of cholangiocarcinoma. Semin Liver Dis 2004; 24 (02) 189-199
  • 18 Valls C, Gumà A, Puig I. et al. Intrahepatic peripheral cholangiocarcinoma: CT evaluation. Abdom Imaging 2000; 25 (05) 490-496
  • 19 Ros PR, Buck JL, Goodman ZD, Ros AM, Olmsted WW. Intrahepatic cholangiocarcinoma: radiologic-pathologic correlation. Radiology 1988; 167 (03) 689-693
  • 20 Maetani Y, Itoh K, Watanabe C. et al. MR imaging of intrahepatic cholangiocarcinoma with pathologic correlation. AJR Am J Roentgenol 2001; 176 (06) 1499-1507
  • 21 Bartella I, Dufour J-F. Clinical diagnosis and staging of intrahepatic cholangiocarcinoma. J Gastrointestin Liver Dis 2015; 24 (04) 481-489
  • 22 Tamandl D, Herberger B, Gruenberger B, Puhalla H, Klinger M, Gruenberger T. Influence of hepatic resection margin on recurrence and survival in intrahepatic cholangiocarcinoma. Ann Surg Oncol 2008; 15 (10) 2787-2794
  • 23 Nathan H, Pawlik TM. Staging of intrahepatic cholangiocarcinoma. Curr Opin Gastroenterol 2010; 26 (03) 269-273
  • 24 Okabayashi T, Yamamoto J, Kosuge T. et al. A new staging system for mass-forming intrahepatic cholangiocarcinoma: analysis of preoperative and postoperative variables. Cancer 2001; 92 (09) 2374-2383
  • 25 Yamasaki S. Intrahepatic cholangiocarcinoma: macroscopic type and stage classification. J Hepatobiliary Pancreat Surg 2003; 10 (04) 288-291
  • 26 Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010; 17 (06) 1471-1474
  • 27 Farges O, Fuks D, Le Treut YP. et al. AJCC 7th edition of TNM staging accurately discriminates outcomes of patients with resectable intrahepatic cholangiocarcinoma: By the AFC-IHCC-2009 study group. Cancer 2011; 117 (10) 2170-2177
  • 28 Wang Y, Li J, Xia Y. et al. Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy. J Clin Oncol 2013; 31 (09) 1188-1195
  • 29 Goere D, Wagholikar GD, Pessaux P. et al. Utility of staging laparoscopy in subsets of biliary cancers: laparoscopy is a powerful diagnostic tool in patients with intrahepatic and gallbladder carcinoma. Surg Endosc 2006; 20 (05) 721-725
  • 30 Weber SM, Jarnagin WR, Klimstra D, DeMatteo RP, Fong Y, Blumgart LH. Intrahepatic cholangiocarcinoma: resectability, recurrence pattern, and outcomes. J Am Coll Surg 2001; 193 (04) 384-391
  • 31 Dodson RM, Weiss MJ, Cosgrove D. et al. Intrahepatic cholangiocarcinoma: management options and emerging therapies. J Am Coll Surg 2013; 217 (04) 736-750.e4
  • 32 Farges O, Fuks D, Boleslawski E. et al. Influence of surgical margins on outcome in patients with intrahepatic cholangiocarcinoma: a multicenter study by the AFC-IHCC-2009 study group. Ann Surg 2011; 254 (05) 824-829 , discussion 830
  • 33 Tan JC, Coburn NG, Baxter NN, Kiss A, Law CH. Surgical management of intrahepatic cholangiocarcinoma--a population-based study. Ann Surg Oncol 2008; 15 (02) 600-608
  • 34 Lang H, Sotiropoulos GC, Sgourakis G. et al. Operations for intrahepatic cholangiocarcinoma: single-institution experience of 158 patients. J Am Coll Surg 2009; 208 (02) 218-228
  • 35 Ohtsuka M, Ito H, Kimura F. et al. Results of surgical treatment for intrahepatic cholangiocarcinoma and clinicopathological factors influencing survival. Br J Surg 2002; 89 (12) 1525-1531
  • 36 Valverde A, Bonhomme N, Farges O, Sauvanet A, Flejou JF, Belghiti J. Resection of intrahepatic cholangiocarcinoma: a Western experience. J Hepatobiliary Pancreat Surg 1999; 6 (02) 122-127
  • 37 Buettner S, van Vugt JL, IJzermans JN, Groot Koerkamp B. Intrahepatic cholangiocarcinoma: current perspectives. OncoTargets Ther 2017; 10: 1131-1142
  • 38 Edge SB, Byrd DR, Carducci MA, Compton CC, Fritz A, Greene F. AJCC cancer staging manual. Vol 7. New York: Springer; 2010
  • 39 Weber SM, Ribero D, O'Reilly EM, Kokudo N, Miyazaki M, Pawlik TM. Intrahepatic cholangiocarcinoma: expert consensus statement. HPB (Oxford) 2015; 17 (08) 669-680
  • 40 Sur MD, In H, Sharpe SM. et al. Defining the benefit of adjuvant therapy following resection for intrahepatic cholangiocarcinoma. Ann Surg Oncol 2015; 22 (07) 2209-2217
  • 41 Hyder O, Hatzaras I, Sotiropoulos GC. et al. Recurrence after operative management of intrahepatic cholangiocarcinoma. Surgery 2013; 153 (06) 811-818
  • 42 Miwa S, Miyagawa S, Kobayashi A. et al. Predictive factors for intrahepatic cholangiocarcinoma recurrence in the liver following surgery. J Gastroenterol 2006; 41 (09) 893-900
  • 43 Morimoto Y, Tanaka Y, Ito T. et al. Long-term survival and prognostic factors in the surgical treatment for intrahepatic cholangiocarcinoma. J Hepatobiliary Pancreat Surg 2003; 10 (06) 432-440
  • 44 Ribero D, Pinna AD, Guglielmi A. et al; Italian Intrahepatic Cholangiocarcinoma Study Group. Surgical approach for long-term survival of patients with intrahepatic cholangiocarcinoma: a multi-institutional analysis of 434 patients. Arch Surg 2012; 147 (12) 1107-1113
  • 45 Choi SB, Kim KS, Choi JY. et al. The prognosis and survival outcome of intrahepatic cholangiocarcinoma following surgical resection: association of lymph node metastasis and lymph node dissection with survival. Ann Surg Oncol 2009; 16 (11) 3048-3056
  • 46 de Jong MC, Nathan H, Sotiropoulos GC. et al. Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol 2011; 29 (23) 3140-3145
  • 47 Shimada K, Sano T, Nara S. et al. Therapeutic value of lymph node dissection during hepatectomy in patients with intrahepatic cholangiocellular carcinoma with negative lymph node involvement. Surgery 2009; 145 (04) 411-416
  • 48 Goldaracena N, Gorgen A, Sapisochin G. Current status of liver transplantation for cholangiocarcinoma. Liver Transpl 2018; 24 (02) 294-303
  • 49 Miura JT, Johnston FM, Tsai S. et al. Chemotherapy for surgically resected intrahepatic cholangiocarcinoma. Ann Surg Oncol 2015; 22 (11) 3716-3723
  • 50 Primrose JN, Fox RP, Palmer DH. et al; BILCAP Study Group. Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study. Lancet Oncol 2019; 20 (05) 663-673
  • 51 Le Roy B, Gelli M, Pittau G. et al. Neoadjuvant chemotherapy for initially unresectable intrahepatic cholangiocarcinoma. Br J Surg 2018; 105 (07) 839-847
  • 52 Valle J, Wasan H, Palmer DH. et al; ABC-02 Trial Investigators. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 2010; 362 (14) 1273-1281
  • 53 Lamarca A, Ross P, Wasan HS. et al. Advanced intrahepatic cholangiocarcinoma: post hoc analysis of the ABC-01, -02, and -03 clinical trials. J Natl Cancer Inst 2020; 112 (02) 200-210
  • 54 Konstantinidis IT, Groot Koerkamp B, Do RK. et al. Unresectable intrahepatic cholangiocarcinoma: Systemic plus hepatic arterial infusion chemotherapy is associated with longer survival in comparison with systemic chemotherapy alone. Cancer 2016; 122 (05) 758-765
  • 55 Kim YI, Park JW, Kim BH. et al. Outcomes of concurrent chemoradiotherapy versus chemotherapy alone for advanced-stage unresectable intrahepatic cholangiocarcinoma. Radiat Oncol 2013; 8: 292
  • 56 Zeng Z-C, Tang Z-Y, Fan J. et al. Consideration of the role of radiotherapy for unresectable intrahepatic cholangiocarcinoma: a retrospective analysis of 75 patients. Cancer J 2006; 12 (02) 113-122
  • 57 Chen Y-X, Zeng Z-C, Tang Z-Y. et al. Determining the role of external beam radiotherapy in unresectable intrahepatic cholangiocarcinoma: a retrospective analysis of 84 patients. BMC Cancer 2010; 10 (01) 492
  • 58 Jiang W, Zeng Z-C, Tang Z-Y. et al. Benefit of radiotherapy for 90 patients with resected intrahepatic cholangiocarcinoma and concurrent lymph node metastases. J Cancer Res Clin Oncol 2010; 136 (09) 1323-1331
  • 59 Shinohara ET, Mitra N, Guo M, Metz JM. Radiation therapy is associated with improved survival in the adjuvant and definitive treatment of intrahepatic cholangiocarcinoma. Int J Radiat Oncol Biol Phys 2008; 72 (05) 1495-1501
  • 60 Tao R, Krishnan S, Bhosale PR. et al. Ablative radiotherapy doses lead to a substantial prolongation of survival in patients with inoperable intrahepatic cholangiocarcinoma: a retrospective dose response analysis. J Clin Oncol 2016; 34 (03) 219-226
  • 61 Labib PL, Davidson BR, Sharma RA, Pereira SP. Locoregional therapies in cholangiocarcinoma. Hepat Oncol 2017; 4 (04) 99-109
  • 62 Gkika E, Hallauer L, Kirste S. et al. Stereotactic body radiotherapy (SBRT) for locally advanced intrahepatic and extrahepatic cholangiocarcinoma. BMC Cancer 2017; 17 (01) 781
  • 63 Mahadevan A, Dagoglu N, Mancias J. et al. Stereotactic body radiotherapy (SBRT) for intrahepatic and hilar cholangiocarcinoma. J Cancer 2015; 6 (11) 1099-1104
  • 64 Hong TS, Wo JY, Yeap BY. et al. Multi-institutional phase II study of high-dose hypofractionated proton beam therapy in patients with localized, unresectable hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol 2016; 34 (05) 460-468
  • 65 Takahashi EA, Kinsman KA, Schmit GD. et al. Thermal ablation of intrahepatic cholangiocarcinoma: Safety, efficacy, and factors affecting local tumor progression. Abdom Radiol (NY) 2018; 43 (12) 3487-3492
  • 66 Xu HX, Wang Y, Lu MD, Liu LN. Percutaneous ultrasound-guided thermal ablation for intrahepatic cholangiocarcinoma. Br J Radiol 2012; 85 (1016): 1078-1084
  • 67 Yu MA, Liang P, Yu XL. et al. Sonography-guided percutaneous microwave ablation of intrahepatic primary cholangiocarcinoma. Eur J Radiol 2011; 80 (02) 548-552
  • 68 Hong K, Georgiades C. Radiofrequency ablation: mechanism of action and devices. J Vasc Interv Radiol 2010; 21 (08) S179-S186
  • 69 Kuhlmann JB, Blum HE. Locoregional therapy for cholangiocarcinoma. Curr Opin Gastroenterol 2013; 29 (03) 324-328
  • 70 Butros SR, Shenoy-Bhangle A, Mueller PR, Arellano RS. Radiofrequency ablation of intrahepatic cholangiocarcinoma: feasibility, local tumor control, and long-term outcome. Clin Imaging 2014; 38 (04) 490-494
  • 71 Fu Y, Yang W, Wu W, Yan K, Xing BC, Chen MH. Radiofrequency ablation in the management of unresectable intrahepatic cholangiocarcinoma. J Vasc Interv Radiol 2012; 23 (05) 642-649
  • 72 Kim JH, Won HJ, Shin YM, Kim KA, Kim PN. Radiofrequency ablation for the treatment of primary intrahepatic cholangiocarcinoma. AJR Am J Roentgenol 2011; 196 (02) W205-W209
  • 73 Carrafiello G, Laganà D, Cotta E. et al. Radiofrequency ablation of intrahepatic cholangiocarcinoma: preliminary experience. Cardiovasc Intervent Radiol 2010; 33 (04) 835-839
  • 74 Chiou YY, Hwang JI, Chou YH, Wang HK, Chiang JH, Chang CY. Percutaneous ultrasound-guided radiofrequency ablation of intrahepatic cholangiocarcinoma. Kaohsiung J Med Sci 2005; 21 (07) 304-309
  • 75 Han K, Ko HK, Kim KW, Won HJ, Shin YM, Kim PN. Radiofrequency ablation in the treatment of unresectable intrahepatic cholangiocarcinoma: systematic review and meta-analysis. J Vasc Interv Radiol 2015; 26 (07) 943-948
  • 76 Kim JH, Won HJ, Shin YM, Kim PN, Lee SG, Hwang S. Radiofrequency ablation for recurrent intrahepatic cholangiocarcinoma after curative resection. Eur J Radiol 2011; 80 (03) e221-e225
  • 77 Park SY, Kim JH, Yoon HJ, Lee IS, Yoon HK, Kim KP. Transarterial chemoembolization versus supportive therapy in the palliative treatment of unresectable intrahepatic cholangiocarcinoma. Clin Radiol 2011; 66 (04) 322-328
  • 78 Herber S, Otto G, Schneider J. et al. Transarterial chemoembolization (TACE) for inoperable intrahepatic cholangiocarcinoma. Cardiovasc Intervent Radiol 2007; 30 (06) 1156-1165
  • 79 Ray Jr CE, Edwards A, Smith MT. et al. Metaanalysis of survival, complications, and imaging response following chemotherapy-based transarterial therapy in patients with unresectable intrahepatic cholangiocarcinoma. J Vasc Interv Radiol 2013; 24 (08) 1218-1226
  • 80 Scheuermann U, Kaths JM, Heise M. et al. Comparison of resection and transarterial chemoembolisation in the treatment of advanced intrahepatic cholangiocarcinoma--a single-center experience. Eur J Surg Oncol 2013; 39 (06) 593-600
  • 81 Shen WF, Zhong W, Liu Q, Sui CJ, Huang YQ, Yang JM. Adjuvant transcatheter arterial chemoembolization for intrahepatic cholangiocarcinoma after curative surgery: retrospective control study. World J Surg 2011; 35 (09) 2083-2091
  • 82 Schiffman SC, Metzger T, Dubel G. et al. Precision hepatic arterial irinotecan therapy in the treatment of unresectable intrahepatic cholangiocellular carcinoma: optimal tolerance and prolonged overall survival. Ann Surg Oncol 2011; 18 (02) 431-438
  • 83 Aliberti C, Benea G, Tilli M, Fiorentini G. Chemoembolization (TACE) of unresectable intrahepatic cholangiocarcinoma with slow-release doxorubicin-eluting beads: preliminary results. Cardiovasc Intervent Radiol 2008; 31 (05) 883-888
  • 84 Poggi G, Amatu A, Montagna B. et al. OEM-TACE: a new therapeutic approach in unresectable intrahepatic cholangiocarcinoma. Cardiovasc Intervent Radiol 2009; 32 (06) 1187-1192
  • 85 Kuhlmann JB, Euringer W, Spangenberg HC. et al. Treatment of unresectable cholangiocarcinoma: conventional transarterial chemoembolization compared with drug eluting bead-transarterial chemoembolization and systemic chemotherapy. Eur J Gastroenterol Hepatol 2012; 24 (04) 437-443
  • 86 Kiefer MV, Albert M, McNally M. et al. Chemoembolization of intrahepatic cholangiocarcinoma with cisplatinum, doxorubicin, mitomycin C, ethiodol, and polyvinyl alcohol: a 2-center study. Cancer 2011; 117 (07) 1498-1505
  • 87 Kim JH, Yoon HK, Sung KB. et al. Transcatheter arterial chemoembolization or chemoinfusion for unresectable intrahepatic cholangiocarcinoma: clinical efficacy and factors influencing outcomes. Cancer 2008; 113 (07) 1614-1622
  • 88 Vogl TJ, Naguib NN, Nour-Eldin NE. et al. Transarterial chemoembolization in the treatment of patients with unresectable cholangiocarcinoma: results and prognostic factors governing treatment success. Int J Cancer 2012; 131 (03) 733-740
  • 89 Currie BM, Soulen MC. Decision making: intra-arterial therapies for cholangiocarcinoma-TACE and TARE. Semin Intervent Radiol 2017; 34 (02) 92-100
  • 90 Kim W, Clark TW, Baum RA, Soulen MC. Risk factors for liver abscess formation after hepatic chemoembolization. J Vasc Interv Radiol 2001; 12 (08) 965-968
  • 91 Tanaka N, Yamakado K, Nakatsuka A, Fujii A, Matsumura K, Takeda K. Arterial chemoinfusion therapy through an implanted port system for patients with unresectable intrahepatic cholangiocarcinoma--initial experience. Eur J Radiol 2002; 41 (01) 42-48
  • 92 Mouli S, Memon K, Baker T. et al. Yttrium-90 radioembolization for intrahepatic cholangiocarcinoma: safety, response, and survival analysis. J Vasc Interv Radiol 2013; 24 (08) 1227-1234
  • 93 Saxena A, Bester L, Chua TC, Chu FC, Morris DL. Yttrium-90 radiotherapy for unresectable intrahepatic cholangiocarcinoma: a preliminary assessment of this novel treatment option. Ann Surg Oncol 2010; 17 (02) 484-491
  • 94 Gangi A, Shah J, Hatfield N. et al. Intrahepatic cholangiocarcinoma treated with transarterial yttrium-90 glass microsphere radioembolization: results of a single institution retrospective study. J Vasc Interv Radiol 2018; 29 (08) 1101-1108
  • 95 Mosconi C, Gramenzi A, Ascanio S. et al. Yttrium-90 radioembolization for unresectable/recurrent intrahepatic cholangiocarcinoma: a survival, efficacy and safety study. Br J Cancer 2016; 115 (03) 297-302
  • 96 Rafi S, Piduru SM, El-Rayes B. et al. Yttrium-90 radioembolization for unresectable standard-chemorefractory intrahepatic cholangiocarcinoma: survival, efficacy, and safety study. Cardiovasc Intervent Radiol 2013; 36 (02) 440-448
  • 97 Buettner S, Braat AJAT, Margonis GA. et al. Yttrium-90 radioembolization in intrahepatic cholangiocarcinoma: a multicenter retrospective analysis. J Vasc Interv Radiol 2020; 31 (07) 1035-1043.e2
  • 98 Al-Adra DP, Gill RS, Axford SJ, Shi X, Kneteman N, Liau SS. Treatment of unresectable intrahepatic cholangiocarcinoma with yttrium-90 radioembolization: a systematic review and pooled analysis. Eur J Surg Oncol 2015; 41 (01) 120-127
  • 99 Edeline J, Touchefeu Y, Guiu B. et al. Radioembolization plus chemotherapy for first-line treatment of locally advanced intrahepatic cholangiocarcinoma: a phase 2 clinical trial. JAMA Oncol 2019; 6 (01) 51-59
  • 100 Edeline J, Du FL, Rayar M. et al. Glass microspheres 90Y selective internal radiation therapy and chemotherapy as first-line treatment of intrahepatic cholangiocarcinoma. Clin Nucl Med 2015; 40 (11) 851-855
  • 101 Hoffmann R-T, Paprottka PM, Schön A. et al. Transarterial hepatic yttrium-90 radioembolization in patients with unresectable intrahepatic cholangiocarcinoma: factors associated with prolonged survival. Cardiovasc Intervent Radiol 2012; 35 (01) 105-116
  • 102 Soydal C, Kucuk ON, Bilgic S, Ibis E. Radioembolization with (90)Y resin microspheres for intrahepatic cholangiocellular carcinoma: prognostic factors. Ann Nucl Med 2016; 30 (01) 29-34
  • 103 Ibrahim SM, Mulcahy MF, Lewandowski RJ. et al. Treatment of unresectable cholangiocarcinoma using yttrium-90 microspheres: results from a pilot study. Cancer 2008; 113 (08) 2119-2128
  • 104 Pauwels B, Korst AE, Lardon F, Vermorken JB. Combined modality therapy of gemcitabine and radiation. Oncologist 2005; 10 (01) 34-51
  • 105 Garlipp B, de Baere T, Damm R. et al. Left-liver hypertrophy after therapeutic right-liver radioembolization is substantial but less than after portal vein embolization. Hepatology 2014; 59 (05) 1864-1873
  • 106 Boehm LM, Jayakrishnan TT, Miura JT. et al. Comparative effectiveness of hepatic artery based therapies for unresectable intrahepatic cholangiocarcinoma. J Surg Oncol 2015; 111 (02) 213-220