title: Impact of intraluminal brachytherapy on survival outcome for radiation therapy for unresectable biliary tract cancer: a propensity-score matched-pair analysis.
abstract: OBJECTIVE
  To determine whether adding intraluminal brachytherapy (ILBT) to definitive radiation therapy (RT) for unresectable biliary tract cancer has a positive impact on survival outcome.
  
  
  METHODS
  The original cohort comprised 209 patients, including 153 who underwent external beam RT (EBRT) alone and 56 who received both ILBT and EBRT. By matching propensity scores, 56 pairs (112 patients) consisting of 1 patient with and 1 patient without ILBT were selected. They were well balanced in terms of sex, age, performance status, clinical stage, jaundice, and addition of chemotherapy. The impact of ILBT on overall survival (OS), disease-specific survival (DSS), and local control (LC) was investigated.
  
  
  RESULTS
  The 2-year OS rates were 31% for the ILBT+ group and 40% for theILBT- group (P=.862). The 2-year DSS rates were 42% for the ILBT+ group and 41% for the ILBT- group (P=.288). The 2-year LC rates were 65% for the ILBT+ group and 35% for the ILBT- group (P=.094). Three of the 4 sensitivity analyses showed a significantly better LC for the ILBT+ group (P=.010, .025, .049), and another showed a marginally better LC (P=.068), and none of the sensitivity analyses showed any statistically significant differences in OS or DSS.
  
  
  CONCLUSIONS
  In the treatment for unresectable biliary tract cancer, the addition of ILBT to RT has no impact on OS or DSS but is associated with better LC. Therefore, the role of ILBT should be addressed by other measures than survival benefit, for example, by less toxicity, prolonged biliary tract patency decreasing the need for further palliative interventions, or patient quality of life.
authors: Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Yasuo
authors: Y
authors: Yoshioka
authors: Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan. Electronic address: kogawa@radonc.med.osaka-u.ac.jp.
authors: Kazuhiko
authors: K
authors: Ogawa
authors: Department of Radiology, Iwate Medical University, Iwate, Japan.
authors: Hirobumi
authors: H
authors: Oikawa
authors: Department of Radiology, University of Yamanashi, Yamanashi, Japan.
authors: Hiroshi
authors: H
authors: Onishi
authors: Department of Radiology, Tokyo Medical University, Tokyo, Japan.
authors: Naoto
authors: N
authors: Kanesaka
authors: Department of Radiation Oncology, Nara Medical University of Medicine, Nara, Japan.
authors: Tetsuro
authors: T
authors: Tamamoto
authors: Department of Radiology, Hamamatsu University School of Medicine, Shizuoka, Japan.
authors: Takashi
authors: T
authors: Kosugi
authors: Department of Radiation Oncology, Chiba Cancer Center, Chiba, Japan.
authors: Kazuo
authors: K
authors: Hatano
authors: Department of Radiology, Jikei University School of Medicine, Tokyo, Japan.
authors: Masao
authors: M
authors: Kobayashi
authors: Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors: Yoshinori
authors: Y
authors: Ito
authors: Department of Radiology, Kyorin University School of Medicine, Tokyo, Japan.
authors: Makoto
authors: M
authors: Takayama
authors: Department of Radiology, Okayama University, Okayama, Japan.
authors: Mitsuhiro
authors: M
authors: Takemoto
authors: Department of Radiation Oncology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
authors: Katsuyuki
authors: K
authors: Karasawa
authors: Department of Radiology, KKR Sapporo Medical Center, Hokkaido, Japan.
authors: Hisayasu
authors: H
authors: Nagakura
authors: Department of Radiation Oncology, Iwata City Hospital, Shizuoka, Japan.
authors: Michiko
authors: M
authors: Imai
authors: Department of Radiation Oncology, Kobe City Medical Center General Hospital, Hyogo, Japan.
authors: Yasuhiro
authors: Y
authors: Kosaka
authors: Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Hideya
authors: H
authors: Yamazaki
authors: Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Fumiaki
authors: F
authors: Isohashi
authors: Department of Radiation Oncology, Yamagata University, Yamagata, Japan.
authors: Kenji
authors: K
authors: Nemoto
authors: Department of Radiation Oncology, Kinki University Faculty of Medicine, Osaka, Japan.
authors: Yasumasa
authors: Y
authors: Nishimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001661:Biliary Tract Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D001918:Brachytherapy / Q000379:methods* / Q000401:mortality*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome