title: Chemoradiation and brachytherapy in biliary tract carcinoma: long-term results.
abstract: OBJECTIVE
  To evaluate long-term effects of chemoradiation and intraluminal brachytherapy in terms of local control, disease-free survival, overall survival, and symptom relief in patients with unresectable or residual extrahepatic biliary carcinoma.
  
  
  METHODS
  Twenty-two patients with unresectable (17 patients) or residual (5 patients) nonmetastatic extrahepatic bile tumors received external beam radiation therapy (39.6-50.4 Gy) between 1991 and 1997. In 21 patients, 5-fluorouracil (96-h continuous infusion, Days 1-4, 1,000 mg/m2/day) was administered. Twelve patients received a boost of intraluminal brachytherapy with 192Ir wires (30-50 Gy) 1 cm from the source axis.
  
  
  RESULTS
  During external beam radiotherapy, 10 patients (45.4%) developed Grade 1 to 2 gastrointestinal toxicity. In patients with unresectable tumor who could be evaluated, the clinical response was 28.6% (4 of 14). Two patients showed complete response. In all 22 patients, median durations of local control, disease-free survival, and overall survival were 44.5 months, 16.3 months, and 23.0 months, respectively. Two patients who received external beam radiation therapy and intraluminal brachytherapy developed late duodenal ulceration. In patients with unresectable tumors, median survival was 13.0 months and 22.0 months in those treated with and without brachytherapy, with 16.7% and no 5-year survival, respectively (p=0.607). Overall 5-year survival was 18.0%: 40% and 11.7% in patients treated with partial resection and in those with unresectable tumor, respectively (p=0.135).
  
  
  CONCLUSIONS
  This study confirmed the role of concurrent chemoradiation in advanced biliary carcinoma; the role of intraluminal brachytherapy boost remains to be further analyzed in larger clinical trials.
authors.affiliation: Department of Radiation Therapy, Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso, Italy. fdeodato@rm.unicatt.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Deodato
authors.forename: Gennaro
authors.initials: G
authors.lastname: Clemente
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Mattiucci
authors.forename: Gabriella
authors.initials: G
authors.lastname: Macchia
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.forename: Felice
authors.initials: F
authors.lastname: Giuliante
authors.forename: Daniela
authors.initials: D
authors.lastname: Smaniotto
authors.forename: Stefano
authors.initials: S
authors.lastname: Luzi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mutignani
authors.forename: Gennaro
authors.initials: G
authors.lastname: Nuzzo
authors.forename: Numa
authors.initials: N
authors.lastname: Cellini
authors.forename: Alessio G
authors.initials: AG
authors.lastname: Morganti
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D017734:Bile Ducts, Extrahepatic; D001918:Brachytherapy / Q000009:adverse effects; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011879:Radiotherapy Dosage
chemical_list: D000964:Antimetabolites, Antineoplastic; D007496:Iridium Radioisotopes; D005472:Fluorouracil