Intraluminal low-dose-rate 192Ir brachytherapy combined with external beam radiotherapy and biliary stenting for unresectable extrahepatic bile duct carcinoma.
OBJECTIVE
To evaluate the results of combined-modality therapy, including external beam radiotherapy, intraluminal (192)Ir, and biliary stenting for extrahepatic bile duct carcinoma.


METHODS
Between 1988 and 1998, 93 patients with unresectable extrahepatic bile duct carcinoma underwent definitive radiotherapy. The dose of external beam radiotherapy was 50 Gy in 25 fractions. Low-dose-rate (192)Ir was delivered at a dose of 27-50 Gy (mean 39.2) at 0.5 cm from the source. An expandable metallic endoprosthesis was used to establish an internal bile passage.


RESULTS
The median survival was 12 months, with a 1-, 3-, and 5-year actuarial survival rate of 50%, 10%, and 4%, respectively. Tumor length, hepatic invasion, and distant metastasis significantly affected survival. Ninety-six percent of patients could successfully remove external drainage catheters. The actuarial biliary patency rate for these patients at 1, 3, and 5 years was 52%, 29%, and 18%, respectively. Tumor length, tumor diameter and T stage were significantly associated with the patency rate. Mild-to-severe gastroduodenal complications were observed in 32 patients and were significantly associated with the active length of (192)Ir and linear source activity. Eight patients had treatment-related biliary fistula.


CONCLUSIONS
Our combined-modality therapy provided reasonable local control and improved the quality of life of patients with extrahepatic bile duct carcinoma. Because none of the treatment characteristics had any impact on survival or biliary patency, lower dose levels and/or a localized target volume are recommended to minimize morbidity.
Takamura
Akio
A
Department of Radiology, Asahikawa Kosei Hospital, Asahikawa, Hokkaido, Japan.
Saito
Hiroya
H
Kamada
Tadashi
T
Hiramatsu
Kazuhide
K
Takeuchi
Shuhei
S
Hasegawa
Masakazu
M
Miyamoto
Noriyuki
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000628:therapy; D017734:Bile Ducts, Extrahepatic; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D011879:Radiotherapy Dosage; D013223:Statistics as Topic; D015607:Stents; D015996:Survival Rate
D007496:Iridium Radioisotopes