Intraluminal brachytherapy in bile duct carcinomas.
BACKGROUND
Cholangiocarcinoma of the biliary tract is a rare tumour which has been treated with surgery, radiotherapy, chemotherapy, bypass procedures and stenting. Surgery remains the only curative treatment for these tumours, but a large proportion are unresectable. Intraluminal brachytherapy has been reported as an effective treatment for localized cholangiocarcinoma of the biliary tract. The purpose of our study was to analyse the survival of patients with biliary tract carcinoma treated with iridium-192 brachytherapy.


METHODS
A retrospective review of patients treated at Peter MacCallum was undertaken. From 1989 to 1994, 16 patients underwent brachytherapy via transhepatic approach for cholangiocarcinoma. There were 12 male and four female patients. The median age was 65 (range 40-83). All patients had cholangiocarcinoma. Prior treatment included complete resection in three, partial resection in one, bypass procedures in eight, endoscopic stents in five and external biliary drainage in 15 of the 16 patients. One patient had received external beam irradiation.


RESULTS
The median survival was 23 months and 61% survived 1 year. The most common acute complication was cholangitis seen in four patients and the most common late complications were duodenal ulcer seen in two patients and cholangitis seen in two patients.


CONCLUSIONS
We conclude that iridium-192 brachytherapy is a safe effective treatment for biliary tract carcinoma but a comparison between surgery and stenting would be of value. However, the cost of brachytherapy is not cheap and its value in this regard should be carefully analysed.
Leung
J
J
Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Guiney
M
M
Das
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D001918:Brachytherapy / Q000379:methods; D018281:Cholangiocarcinoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007496:Iridium Radioisotopes / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
D007496:Iridium Radioisotopes