Real-World Efficacy of Radioembolization With or Without Chemotherapy in Patients with Locally Advanced Intrahepatic Cholangiocarcinoma

Background: Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver malignancy and is associated with a poor prognosis. It is often diagnosed at an advanced stage, making it ineligible for curative treatments. The combination of locoregional therapies, such as selective internal radiation therapy (SIRT), and systemic therapies shows promise for locally advanced iCCA (LAiCCA). However, few studies have evaluated the benefit of SIRT in real-world practice. Methods: This retrospective single-center study involved patients treated with SIRT for LAiCCA between 2016 and 2023. Results: Of 28 patients treated with SIRT, 15 also received systemic therapy. The median overall survival was 17.1 months, with no significant difference between the groups (17.5 months for SIRT alone vs. 16.7 months for SIRT plus systemic therapy; hazard ratio: 1.573; 95% confidence interval: 0.524–4.722; p = 0.41). At the first reassessment, the objective response rate was 60.7% (similar between the groups), and the disease control rate was 75% (86.7% in the combined group vs. 61.5% in the SIRT-only group; p = 0.12). Four patients underwent surgical resection after treatment. SIRT was well tolerated, with only one grade > 1 adverse event reported. Conclusion: SIRT demonstrated promising outcomes for LAiCCA in a real-world setting, with comparable survival outcomes irrespective of the addition of systemic therapy. For frail older patients with comorbidities, SIRT monotherapy could represent a viable and valuable alternative.