Malignant biliary duct obstruction: long-term experience with Gianturco stents and combined-modality radiation therapy.
OBJECTIVE
To evaluate the effect of combined-modality therapy including intraluminal iridium-192 on stent patency and survival in patients with malignant biliary obstruction treated with Gianturco stents.


METHODS
Twenty-two patients with unresectable biliary obstruction caused by cholangiocarcinoma (n = 11) or by secondary extrahepatic bile duct malignant tumors (n = 11) were treated with percutaneous biliary drainage followed by intraluminal Ir-192 wire placement (mean dose, 25 Gy) before insertion of Gianturco metal stents. Eleven patients also received external-beam radiation therapy, and 13 patients received chemotherapy. Patency was defined as absence of jaundice or cholangitis that necessitated hospitalization, or as seen on hepatobiliary scans. Survival was determined from the time of stent insertion after brachytherapy.


RESULTS
Patients with cholangiocarcinoma had extended mean stent patency of 19.5 months (range, 2-46 months) and mean survival of 22.6 months (range, 2-72 months). Patients with secondary malignant tumors had a mean patency of 4.8 months (range, 1.5-8 months) and a mean survival of 5.3 months (range, 2-9 months).


CONCLUSIONS
Radiation therapy including intraluminal Ir-192 appears to extend stent patency and survival in patients with inoperable cholangiocarcinoma treated with Gianturco metal stents compared with patients with other extrahepatic bile duct malignant diseases and patients treated without combined-modality therapy in other studies.
Eschelman
D J
DJ
Department of Radiology, Thomas Jefferson University Hospital, Jefferson Medical College, Philadelphia, PA 19107, USA.
Shapiro
M J
MJ
Bonn
J
J
Sullivan
K L
KL
Alden
M E
ME
Hovsepian
D M
DM
Gardiner
G A
GA
D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D001918:Brachytherapy; D018281:Cholangiocarcinoma / Q000150:complications / Q000401:mortality / Q000628:therapy*; D002780:Cholestasis, Intrahepatic / Q000209:etiology / Q000628:therapy*; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D007496:Iridium Radioisotopes