Transduodenal intraluminal high dose rate brachytherapy in the treatment of carcinomas of the subhepatic region.
OBJECTIVE
The prognosis of carcinomas of the subhepatic region is poor, and therapeutic efforts are limited mostly to palliation. The aim of this study was to retrospectively evaluate the effectiveness of transduodenal administration of intraluminal high dose rate brachytherapy in the palliative treatment of bile duct and pancreatic head carcinomas.


METHODS
Twelve patients with inoperable bile duct and pancreatic head carcinomas were treated by transduodenal brachytherapy using high dose rate remote afterloading system. Eleven patients were treated by intraluminal brachytherapy inserted via a nasobiliary drain and one patient by intraluminal brachytherapy via a nasopancreatic drain inserted in the duct of Wirsung.


RESULTS
After transduodenal intraluminal brachytherapy, a control of icterus was observed in all patients. The treatment was well tolerated with the mean survival of 284 days.


CONCLUSIONS
Transduodenal intraluminal brachytherapy is technically feasible. The addition of intraluminal brachytherapy may be beneficial to patients in whom drainage can be established. Transduodenal insertion of brachytherapy is not competitive to the percutaneous approach but spreads the possibilities of the treatment of bile duct carcinoma. Intraluminal brachytherapy of pancreatic head carcinoma is feasible only via transduodenal approach.
Dvorák
Josef
J
Department of Oncology and Radiotherapy, Charles University Medical School & Teaching Hospital, Hradec Králové, 50005, Czech Republic. dvorakj@fnhk.cz
Petera
Jirí
J
Papík
Zdenek
Z
Melichar
Bohuslav
B
Vanásek
Tomás
T
Hulek
Petr
P
Jandík
Pavel
P
Mergancová
Jindriska
J
Zoul
Zdenek
Z
Vacek
Zdenek
Z
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D001918:Brachytherapy / Q000379:methods*; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002779:Cholestasis / Q000532:radiotherapy*; D004322:Drainage / Q000379:methods; D004386:Duodenum; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006500:Hepatic Duct, Common / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome