part of 10.2217/fon-2017-0022 © 2017 Future Medicine Ltd DRUG EVALUATION Yttrium-90 microsphere radioembolization in unresectable intrahepatic cholangiocarcinoma Cristina Mosconi* ,1 , Alberta Cappelli 1 , Salvatore Ascanio 1 , Irene Pettinari 1 , Francesco Modestino 1 , Matteo Renzulli 1 , Maria Cristina Galaverni 1 , Alessandro Cucchetti 2 , Annagiulia Gramenzi 3 , Cinzia Pettinato 4 & Rita Golferi 1 1 Radiology Unit, Department of Diagnostic & Preventive Medicine, S Orsola-Malpighi University Hospital, Bologna, Italy 2 Department of Medical & Surgical Sciences, S.Orsola – Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Italy 3 Department of Medical & Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy 4 Medical Physics Unit, Radiology Unit, S Orsola-Malpighi Hospital, Bologna, Italy *Author for correspondence: Tel.: +39 051 6362598; Fax: +39 051 6362699; cristina.mosconi@aosp.bo.it Intrahepatic cholangiocarcinoma is increasing in frequency worldwide, but radical surgical treatment is practicable in 30–40% of cases. The median survival without therapy is about 8 months, increased to 12 months in combination with systemic chemotherapy. Therefore, locoregional therapies, such as, radiofrequency ablation or transarterial chemoembolization have been employed. Radioembolization with yttrium-90 microspheres ( 90 Y-TARE) is a novel intrarterial treatment which could be included in the armamentarium of treatment options, having shown higher median survival (up to 22 months) and low complication rates. Evidence-based algorithms for staging and allocation to treatment should be defned in the future, after robust results obtained through randomized controlled trials, thus establishing the exact role and timing of 90 Y-TARE in the treatment protocol of unresectable intrahepatic cholangiocarcinoma. First draft submitted: 13 February 2017; Accepted for publication: 7 March 2017; Published online: 27 March 2017 KEYWORDS • ICC • intrahepatic cholangiocarcinoma •  radioembolization • yttrium-90 Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer after hepatocellular carcinoma (HCC) [1] . Although relatively rare, its incidence is increasing worldwide, accounting for up to 15% of primary liver cancers with an age-adjusted rate of about 2.1/100,000 people per year in western countries [1,2] . The only potential curative treatment is surgical treatment: however, only 30–40% of ICCs are diagnosed at a stage which meets the criteria for curative resection [1] . Moreover, curative-intent surgery is mainly limited by the high recurrence rate of this cancer; however, it can increase median overall survival (OS) from 27 to 36 months. If untreated, unresectable ICCs have a median survival of less than 8 months [3,4] which can be increased to approximately 12 months with systemic chemotherapy (gemcitabine and cisplatin) [1,5] . For these reasons, locoregional therapies, such as, radiofrequency ablation or transarterial thera- pies, including hepatic artery infusion (HAI), transarterial chemoembolization (TACE), drug- eluting bead TACE (DEB-TACE) have been employed. Radiofrequency ablation has been proven to achieve good results in patients with small, single ICCs, leading to a median survival ranging from 33 to 38.5 months [6–9] ; furthermore, transarterial therapies have also been demonstrated to be superior to supportive care in patients with unresectable ICC, allowing a cumulative median OS rate of 12.4 months from the date of treatment [10] . Nevertheless, due to the heterogeneity of Future Oncol. (Epub ahead of print) ISSN 1479-6694 For reprint orders, please contact: reprints@futuremedicine.com