title: Prevention of implantation metastases after resection of proximal bile duct tumours with pre-operative low dose radiation therapy.
abstract: OBJECTIVE
  Pre-operative endoscopic retrograde cholangiopancreatography (ERCP) with biliary drainage is associated with a greater risk of implantation metastases after resection of proximal bile duct tumours. In a previous study among patients who had undergone biliary drainage before resection, eight patients (20%) developed implantation metastases, within 1 year following resection. The aim of this analysis was to evaluate the results of pre-operative irradiation with regard to a possible reduction of implantation metastases.
  
  
  METHODS
  Twenty-one patients with proximal bile duct tumours who had undergone resection following pre-operative irradiation were retrospectively analysed. Pre-operative radiation therapy consisted of three fractions of 3.5 Gy external beam irradiation of the hilar area.
  
  
  RESULTS
  Pre-operative biliary drainage was performed in 19 patients (90%). All patients received pre-operative radiotherapy during which no complications were noted. None of the patients developed implantation metastases within a follow-up time of 2 to 79 months.
  
  
  CONCLUSIONS
  The results of this study suggest that pre-operative radiotherapy in patients with a resectable proximal bile duct tumour who have undergone pre-operative drainage, decreases the risk of implantation metastases. To be certain about the role of pre-operative radiotherapy, a randomized study is required. Until then, we advocate standard low dose radiotherapy preceding resection in all patients with lesions suggestive of a proximal bile duct tumour who have undergone biliary drainage.
authors.affiliation: Department of Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands.
authors.forename: M F
authors.initials: MF
authors.lastname: Gerhards
authors.forename: D G
authors.initials: DG
authors.lastname: Gonzalez
authors.forename: H
authors.initials: H
authors.lastname: ten Hoopen-Neumann
authors.forename: T M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: L T
authors.initials: LT
authors.lastname: de Wit
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000517:prevention & control* / Q000532:radiotherapy* / Q000601:surgery; D017734:Bile Ducts, Extrahepatic; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects*; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009366:Neoplasm Seeding; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome