Combined external beam and intraluminal radiotherapy for irresectable Klatskin tumors.
BACKGROUND
In most cases of proximal cholangiocarcinoma, curative surgery is not possible. Radiotherapy can be used for palliative treatment. We report our experience with combined external beam and intraluminal radiotherapy of advanced Klatskin's tumors.


METHODS
30 patients were treated for extrahepatic proximal bile duct cancer. Our schedule consisted of external beam radiotherapy (median dose 30 Gy) and a high-dose-rate brachytherapy boost (median dose 40 Gy) delivered in four of five fractions, which could be applied completely in twelve of our patients. 15 patients in the brachytherapy and nine patients in the non-brachytherapy group received additional low-dose chemotherapy with 5-fluorouracil.


RESULTS
The brachytherapy boost dose improved the effect of external beam radiotherapy by increasing survival from a median of 3.9 months in the non-brachytherapy group to 9.1 months in the brachytherapy group. The effect was obvious in patients receiving a brachytherapy dose above 30 Gy, and in those without jaundice at the beginning of radiotherapy (p < 0.05).


CONCLUSIONS
The poor prognosis in patients with advanced Klatskin's tumors may be improved by combination therapy, with the role of brachytherapy and chemotherapy still to be defined. Our results suggest that patients without jaundice should be offered brachytherapy, and that a full dose of more than 30 Gy should be applied.
Schleicher
Ursula Maria
UM
Klinik für Strahlentherapie der Rheinisch-Westfälischen Technischen Hochschule Aachen, Germany. ursula.schleicher@post.rwth-aachen.de
Staatz
Gundula
G
Alzen
Gerhard
G
Andreopoulos
Demetrios
D
D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D001918:Brachytherapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006500:Hepatic Duct, Common / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects; D006801:Humans; D018285:Klatskin Tumor / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D015996:Survival Rate
D005472:Fluorouracil