title: Evaluation of high-dose-rate intraluminal brachytherapy by percutaneous transhepatic biliary drainage in the palliative management of malignant biliary obstruction--a pilot study.
abstract: OBJECTIVE
  To evaluate the role of high-dose-rate intraluminal brachytherapy (ILBT) through percutaneous transhepatic biliary drainage (PTBD) in patients with malignant biliary obstruction, in terms of improvement in symptoms, quality of life (QOL), and survival.
  
  
  METHODS
  From August 2004 to October 2006, 18 patients aged 30-70 years, who were found unsuitable for surgical resection or were inoperable because of poor general condition, were taken up for palliative ILBT through PTBD. All patients underwent PTBD followed by internal-external drainage. After a gap of 1 week, high-dose-rate ILBT was performed by delivering a dose of 800cGy prescribed at 1cm from the central axis of the catheter. Two such sessions were given 1 week apart.
  
  
  RESULTS
  The mean fall in bilirubin was 11.37mg% after PTBD and further 2.94mg% after ILBT. The overall response rates were 100% and 80% for pruritus and icterus, respectively. Improvement in appetite and weight gain was seen in 93.3% and 86.7% patients, respectively, at last followup. The median followup and survival duration were 7.3 and 8.27 months, respectively. Actuarial survival at 6 months was 61.11%. Treatment-related major complications were not seen in any of the patients. QOL showed significant improvement in global health status and most functional and symptom scales.
  
  
  CONCLUSIONS
  This prospective pilot study demonstrated that PTBD followed by ILBT is a feasible procedure with good symptom control, definite impact on QOL, and minimal complications in such patients. A prospective randomized study is required to more accurately assess the benefit of ILBT compared with biliary drainage alone.
authors.affiliation: Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. rupali_agg@yahoo.co.in
authors.forename: Rupali
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Firuza Darius
authors.initials: FD
authors.lastname: Patel
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kapoor
authors.forename: Mandeep
authors.initials: M
authors.lastname: Kang
authors.forename: Pankaj
authors.initials: P
authors.lastname: Kumar
authors.forename: Suresh
authors.initials: S
authors.lastname: Chander Sharma
mesh_terms: D000328:Adult; D001661:Biliary Tract Neoplasms / Q000150:complications* / Q000532:radiotherapy*; D001918:Brachytherapy / Q000379:methods*; D002779:Cholestasis / Q000209:etiology* / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010865:Pilot Projects; D011879:Radiotherapy Dosage; D016896:Treatment Outcome