Chemoradiation and brachytherapy in biliary tract carcinoma: long-term results.
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.
Deodato
Francesco
F
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
Clemente
Gennaro
G
Mattiucci
Gian Carlo
GC
Macchia
Gabriella
G
Costamagna
Guido
G
Giuliante
Felice
F
Smaniotto
Daniela
D
Luzi
Stefano
S
Valentini
Vincenzo
V
Mutignani
Massimiliano
M
Nuzzo
Gennaro
G
Cellini
Numa
N
Morganti
Alessio G
AG
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
D000964:Antimetabolites, Antineoplastic; D007496:Iridium Radioisotopes; D005472:Fluorouracil