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Article 23, 3/2016

CASE REPORT

Multimodal Therapy including Yttrium-90 Radioembolization as a Bridging Therapy to Liver Transplantation for a Huge and Locally Advanced Intrahepatic Cholangiocarcinoma

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Michel Rayar1,2,3, Giovanni Battista Levi Sandri1, Pauline Houssel-Debry2,4, Christophe Camus2,5, Laurent Sulpice1,2,3, Karim Boudjema1,2,3

1) CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive;
2) INSERM, U1414, Centre d’Investigation Clinique, Rennes;
3) Université Rennes 1, Faculté de Médecine;
4) CHU Rennes, Service des maladies du foie;
5) CHU Rennes, Réanimation médicale; F-35033 Rennes, France

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.253.y90

ABSTRACT
Treatment of intrahepatic cholangiocarcinoma remains a major challenge. For an unresectable lesion without extrahepatic spread, liver transplantation could be a potential solution but it is still associated with poor oncologic results owing to the absence of effective neoadjuvant treatment. We report the case of a young man with locally advanced intrahepatic cholangiocarcinoma presenting with multiple intrahepatic metastases and vascular structure involvement. The lesion was significantly downstaged by a multimodal therapy including intra-arterial Yttrium-90 radioembolization, systemic chemotherapy and external radiotherapy, allowing liver transplantation. Three years after the procedure, oncologic outcome is excellent with no sign of recurrence.
Multimodal therapy including Yttrium-90 radioembolization could be relevant as neoadjuvant treatment before liver transplantation for unresectable intrahepatic cholangiocarcinoma.

Key words: liver transplantation − intrahepatic cholangiocarcinoma − radioembolization − Yttrium.

Abbrevations: CA 19-9: carbohydrate antigen 19-9; FDG-PET: fluorodeoxyglucose positron emission tomography; HCC: hepatocellular carcinoma; ICC: intrahepatic cholangiocarcinoma; LT: liver transplantation; MRI: magnetic resonance imaging; PHC: perihilar cholangiocarcinoma; Ytt-90: Yttrium-90.