ABSTRACT
PURPOSE: To evaluate outcomes of yttrium-90 radioembolization in patients with combined biphenotypic hepatocellular-cholangiocarcinoma (cHCC-CC). MATERIALS AND METHODS: A retrospective review of patients with biopsy-confirmed cHCC-CC treated with yttrium-90 radioembolization between 2012 and 2018 was performed. Twenty-two patients with cHCC-CC (mean age 65.6 y, 17 men, 5 women) underwent 29 radioembolization treatments (5 resin, 24 glass microspheres). Survival data were available in 21 patients, and hepatic imaging response data were available in 20 patients. Hepatic imaging response to radioembolization was assessed on follow-up CT or MR imaging using modified Response Evaluation Criteria In Solid Tumours criteria. Univariate stepwise Cox regression analysis was used to evaluate the association between demographic and clinical factors and survival. Logistic regression evaluated associations between clinical factors and response to treatment, overall response, and disease control. RESULTS: Hepatic imaging response was as follows: 15% complete response, 40% partial response, 10% stable disease, and 35% progressive disease (55% response rate, 65% disease control rate). Two patients were downstaged or bridged to transplant, and 1 patient was downstaged to resection. Median overall survival was 9.3 mo (range, 2.5-31.0 mo) from time of radioembolization. Nonreponse to treatment, bilobar disease, presence of multiple tumors, and elevated carbohydrate antigen 19-9 before treatment were associated with reduced survival after radioembolization. CONCLUSIONS: Radioembolization is a viable option for locoregional control of cHCC-CC with good response and disease control rates.
Subject(s)
Bile Duct Neoplasms/radiotherapy , Carcinoma, Hepatocellular/radiotherapy , Cholangiocarcinoma/radiotherapy , Embolization, Therapeutic , Liver Neoplasms/radiotherapy , Neoplasms, Complex and Mixed/radiotherapy , Radiopharmaceuticals/administration & dosage , Yttrium Radioisotopes/administration & dosage , Aged , Bile Duct Neoplasms/diagnostic imaging , Bile Duct Neoplasms/mortality , Bile Duct Neoplasms/pathology , CA-19-9 Antigen/blood , Carcinoma, Hepatocellular/diagnostic imaging , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/secondary , Cholangiocarcinoma/diagnostic imaging , Cholangiocarcinoma/mortality , Cholangiocarcinoma/secondary , Embolization, Therapeutic/adverse effects , Embolization, Therapeutic/mortality , Female , Humans , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/mortality , Liver Neoplasms/pathology , Male , Middle Aged , Neoplasm Staging , Neoplasms, Complex and Mixed/diagnostic imaging , Neoplasms, Complex and Mixed/mortality , Neoplasms, Complex and Mixed/pathology , Phenotype , Radiopharmaceuticals/adverse effects , Retrospective Studies , Time Factors , Treatment Outcome , Yttrium Radioisotopes/adverse effectsABSTRACT
Metaplastic carcinoma of the breast, a rare neoplasm, usually presents at an advanced stage, metastasises to distant sites more frequently, has higher Ki-67 expression and is more often triple negative compared with other invasive breast cancers. Here, the authors discuss a case of an 84-year-old woman with triple negative mixed metaplastic breast carcinoma treated with radical modified mastectomy, axillary lymph node dissection and radiation therapy. Because of the rarity of the disease, the pathogenesis and the management remain controversial, thus contributing to overall poor prognosis.
