Intraoperative radiotherapy for resectable extrahepatic bile duct cancer.
OBJECTIVE
Through a retrospective study of intraoperative radiation therapy (IORT) in bile duct cancer, we hope to help clarify its clinical usefulness.


METHODS
Between 1976 and 1996, IORT was carried out in 35 patients with bile duct cancer at the Tokyo Metropolitan Komagome Hospital. Of the 35 patients, resection proved to be curative in 15. Intraoperative irradiation of 15-30 Gy (average 20.1 Gy) was delivered by electron beam in the 5- to 19-MeV energy ranges. Postoperative external-beam radiation therapy (EBRT) was also delivered in 16 patients. The EBRT was fractionated to 2 Gy/day, in principle, and was delivered at 8.8-54 Gy (average 40.4 Gy) by 10-MV X-rays.


RESULTS
The median survival in our patients was 19 months. The 1-year, 2-year, and 5-year survival rates were 57%, 43%, and 19%, respectively. Statistical analysis identified the following prognostic factors: performance status, curative surgical resection, lymph node metastasis, IORT dosage, and treatment period. Only 1 patient (3%) died within 30 days after surgery, and the incidence of late-onset complications was 21%.


CONCLUSIONS
The combination of IORT and EBRT is useful for patients with bile duct cancer who undergo noncurative resection or who have lymph node metastasis.
Kurosaki
H
H
Department of Radiation Therapy, Tokyo Metropolitan Komagome Hospital, Japan. hkurosak@sb.gunma-u.ac.jp
Karasawa
K
K
Kaizu
T
T
Matsuda
T
T
Okamoto
A
A
Sato
T
T
Ebara
T
T
Tanaka
Y
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D001652:Bile Ducts / Q000473:pathology / Q000528:radiation effects; D017734:Bile Ducts, Extrahepatic / Q000601:surgery*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate