title: Unresectable perihilar cholangiocarcinoma: multimodal palliative treatment.
abstract: OBJECTIVE
  To evaluate the survival of patients with unresectable perihilar cholangiocarcinoma (PHC) treated with multimodal palliative approaches.
  
  
  METHODS
  thirty-two patients were enrolled in a multimodal protocol including: bilateral biliary drainage; Yridium-192 intraluminal brachytherapy (BT); metal biliary stenting; external-beam radiotherapy (EBRT); systemic chemotherapy (ChT). All patients underwent BT and biliary stenting: this was the only treatment for 14 patients, it was combined with EBRT in 11, and with EBRT and ChT in seven. Mean and median survival, complication rates and duration of hospital stay were calculated for each group.
  
  
  RESULTS
  BT with EBRT and ChT obtained the best median (15 months) and one year (71.42%) survival followed by BT with EBRT (14 months and 63.63%, respectively). BT with EBRT in a total dose of 54-60 Gy, with or without ChT, led to a significantly higher median survival rate (14 months) than that for BT alone (seven months).
  
  
  CONCLUSIONS
  BT with EBRT, with or without ChT, improves survival and should be considered as a suitable alternative to palliative surgery for patients with unresectable perihilar cholangiocarcinoma.
authors.affiliation: Radiology Unit, Department of Digestive Diseases and Internal Medicine, General Hospital Sant’Orsola Malpighi, University of Bologna, Bologna, Italy. cristina.mosconi@aosp.bo.it
authors.forename: Cristina
authors.initials: C
authors.lastname: Mosconi
authors.forename: Matteo
authors.initials: M
authors.lastname: Renzulli
authors.forename: Emanuela
authors.initials: E
authors.lastname: Giampalma
authors.forename: Andrea
authors.initials: A
authors.lastname: Galuppi
authors.forename: Caterina
authors.initials: C
authors.lastname: Balacchi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Brandi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bianchi
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D001662:Biliary Tract Surgical Procedures; D001918:Brachytherapy; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D007496:Iridium Radioisotopes
keywords: Biliary tract neoplasms; Yridium radioisotopes; brachytherapy; expandable metallic stents; radiotherapy