[Clinical value of brachytherapy of malignant biliary obstruction after implanting expandable metallic biliary endoprothesis (EMBE)].
OBJECTIVE
For malignant biliary obstruction,drainage is the only procedure to cope with jaundice itself. It does not work for neoplasm. Patient will die of disease progress in a short time.With after-loading radiotherapy,radiofrequency ablation(RFA) and port catheter system(PCS) chemotherapy,we can directly apply these methods to treat neoplasm. This study is to investigate the value of after-loading treatment through biliary drainage and local chemotherapy embolism of PCS and RFA on treatment of malignant biliary obstruction after Expandable Metallic stent placement. Materials and Methods 49 cases with malignant biliary obstruction can not or do not be suit for surgical treatment, including hepatic portal tumor 25 cases (17 with primary hepatocellular carcinoma,8 with metastasis carcinoma), biliary carcinoma 11 cases, pancreatic carcinoma 6 cases, Clastkin tumor 7 cases. These patients were divided into four groups in random sampling. One underwent EMBE, the second underwent both EMBE and after-loading treatment,the third group underwent both EMBE and RFA, The last underwent both EMBE and PCS. EMBE of Percutaneous biliary drainage were placed in these patients first. The second group was given after-loading treatment then. The third group was given RFA after EMBE. PCS were done in the last group. Chemotherapeutic agents were infused through PCS according to characteristics of biology and pharmacokinetics.


RESULTS
49 cases were successfully placed EMBE. In 49, 13 cases underwent EMBE, 16 cases underwent after-loading treatment after EMBE, 9 cases received RFA treatment, 11 cases underwent PCS after EMBE. Follow-up time was 1-12 months. For group EMBE: 6 cases (46.1%) developed re-obstruction in 1-3 months, 8 cases(61.5%)died in 2-6 months ,11 cases (84.6%)died in 12 months; for group after-loading:4 cases (25.0%) reobstructed in 1-3 months, 5 cases(31.25%) died in 2-6 months, 6 cases(37.5%) died in 12 months; for group EMBE and RFA: 2 cases (22.2%) reobstructed in 1-3 months ,2 cases (22.2%) died in 2-6 months, 3 cases (33.3%) died in 12 months;for group EMBE and PCS:3 cases (27.27%) reobstructed in 1-3 months ,5 cases (45.45% ) died in 2-6 months, 6 cases (54.54%) died in 12 months. The four groups have significant difference in reobstruction rate and mortality rate, by T-test (P< 0.01). conclusion EMBE combined with brachytherapy is more effective methods than EMBE in treatment of malignant biliary obstruction.
Zhang
Fu-Jun
FJ
Department of Intervention Therapy, Changzheng Hospital, The Seond Military Medical University, Shanghai,200003, P.R.China.
Wu
Pei-Hong
PH
Gu
Yang-Kui
YK
Zhao
Ming
M
Fan
Wei-Jun
WJ
Xiao
Xiang-Sheng
XS
D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000628:therapy*; D001918:Brachytherapy; D017115:Catheter Ablation; D002408:Catheters, Indwelling; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery; D006801:Humans; D015918:Infusion Pumps, Implantable; D008113:Liver Neoplasms / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000628:therapy; D015607:Stents