title: Combination of external beam irradiation and high-dose-rate intraluminal brachytherapy for inoperable carcinoma of the extrahepatic bile ducts.
abstract: OBJECTIVE
  To assess the feasibility and therapeutic benefits of a combination of external beam radiotherapy (EBRT) and high-dose-rate intraluminal brachytherapy (ILBT) for treating patients with inoperable carcinoma of the extrahepatic bile ducts.
  
  
  METHODS
  Of 31 patients who received RT at the Yonsei Cancer Center, Yonsei University College of Medicine in Seoul, Korea between 1986 and 1995, 17 patients underwent EBRT alone (Group 1) and 14 patients were treated with EBRT in combination with high-dose-rate ILBT (Group 2). After external drainage, EBRT was delivered with a total dose ranging from 36 to 55 Gy (median 50.4) in both groups. High-dose-rate ILBT for the patients in Group 2 was performed using a high-intensity (192)Ir source (Gamma-med remote afterloading system) within the expandable intrabiliary prosthesis (Gianturco stent), inserted transhepatically at the site of the obstruction. The radiation dose of the high-dose-rate ILBT was prescribed at 1.5 cm from the center of the source with a single daily dose of 5 Gy to a total of 15 Gy given in three fractions. The response rate, patterns of treatment failure, treatment morbidity, and survival data in the two groups were compared.
  
  
  RESULTS
  Although locoregional recurrence was the most common pattern of failure in both groups, no statistically significant difference was found in the recurrence rates between those who did and did not receive ILBT (53% for Group 1 vs. 36% for Group 2; p > 0.05). However, a prolongation of the median time to tumor recurrence was observed in the Group 2 patients (5 months for Group 1 vs. 9 months for Group 2; p = 0.06). When the EBRT dose delivered was >50 Gy, most patients experienced various degrees of GI symptoms, but the frequency of radiation-induced complications in the two groups was similar. No enhancement in treatment morbidity was attributed to the addition of high-dose-rate ILBT to EBRT. With a median follow-up of 12 months, the overall actuarial 2-year survival rate for Group 2 patients was significantly better than that for Group 1 patients (0% for Group 1 vs. 21% for Group 2; p = 0.015).
  
  
  CONCLUSIONS
  Given these observations, we believe that the combined use of EBRT and high-dose-rate ILBT is a beneficial, relatively safe, and effective method of improving the treatment outcome in selected patients with inoperable carcinoma of the extrahepatic bile ducts.
authors.affiliation: Department of Radiation Oncology, Pundang CHA General Hospital, Sungnam, South Korea.
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Shin
authors.forename: Jinsil
authors.initials: J
authors.lastname: Seong
authors.forename: Woo Chul
authors.initials: WC
authors.lastname: Kim
authors.forename: Hyung Sik
authors.initials: HS
authors.lastname: Lee
authors.forename: Sun Rock
authors.initials: SR
authors.lastname: Moon
authors.forename: Ik Jae
authors.initials: IJ
authors.lastname: Lee
authors.forename: Kang Kyu
authors.initials: KK
authors.lastname: Lee
authors.forename: Kyung Ran
authors.initials: KR
authors.lastname: Park
authors.forename: Chang Ok
authors.initials: CO
authors.lastname: Suh
authors.forename: Gwi Eon
authors.initials: GE
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000532:radiotherapy*; D017734:Bile Ducts, Extrahepatic; D001918:Brachytherapy / Q000379:methods; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality; D011878:Radiotherapy / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome