Published online May 7, 2014. doi: 10.3748/wjg.v20.i17.5131
Revised: December 25, 2013
Accepted: February 20, 2014
Published online: May 7, 2014
We report the case of a 57-year-old man who was diagnosed with a large unresectable cholangiocarcinoma associated with 2 satellite nodules and without clear margins with the right hepatic vein. Despite 4 cycles of GEMOX (stopped due to a hypertransaminasemia believed to be due to gemcitabine) and 4 cycles of FOLFIRINOX, the tumor remained stable and continued to be considered unresectable. Radioembolization (resin microspheres, SIRS-spheres®) targeting the left liver (474 MBq) and segment IV (440 MBq) was performed. This injection was very well tolerated, and 4 more cycles of FOLFIRINOX were given while waiting for radioembolization efficacy. On computed tomography scan, a partial response was observed; the tumor was far less hypervascularized, and a margin was observed between the tumor and the right hepatic vein. A left hepatectomy enlarged to segment VIII was performed. On pathological exam, most of the tumor was acellular, with dense fibrosis around visible microspheres. Viable cells were observed only at a distance from beads. Radioembolization can be useful in the treatment of cholangiocarcinoma, allowing in some cases a secondary resection.
Core tip: A 57-year-old man with abdominal pain was diagnosed with a large unresectable hepatic tumor. On liver biopsy, this intrahepatic cholangiocarcinoma was observed within the normal liver parenchyma. After 2 systemic chemotherapy regimens, the tumor remained stable. A radioembolization (SIRS-Spheres®) delivering 120 Gy to the tumor, 7 Gy to the normal liver and 4 Gy to the lungs was performed. Three months later, the tumor was less vascularized and had shrunk, and a resection could be performed. On pathological examination, most of the tumor was acellular with fibrosis centered on microspheres, and only a few viable cells were noticed.