title: [Efficacy of Combined Therapy(Drainage of the Bile Duct, High-Dose Hepatic Artery Infusion, and Radiation)for Hilar Cholangiocellularcarcinoma with Complete Portal Vein Obstruction].
abstract: We reported a case of hilar cholangiocellularcarcinoma with complete obstruction of the portal vein. The patient, who was a 65-year-old woman, suffered from fever and general fatigue as a result of acute cholangitis after insertion of a tube stent into the right bile duct. The main tumor was present on the right side of S1 and spread to both sides of the bile duct. S1 lobe was swollen and diffuse intrahepatic invasion was noted in the right lobe and S1. The portal vein was completely obstructed at the porta hepatis with a coronary vein-left renal vein shunt. We immediately administered a high-dose hepatic arterialinfusion( 5-FU 1 g×3 days: one day off 1 g×3 days)(HDHAI)to the right hepatic artery using a transient catheter insertion method. After 2 courses of HDHAI, the intrahepatic invasion decreased. However, after 4 courses of HDHAI(2 on the right side and 2 on the left side), the invasion on the left side of the IVC had increased. We then chose radiation therapy. Subsequently, transient cystic changes were observed; however, 4 months after radiation, the invasion on the left side of the IVC had regrown into the cardia. The patient suffered from vomiting as a result of the narrowing of the esophagus. We chose HDHAI and dilation of the esophagus using a balloon. Finally, the invasion on the left side of the IVC and S1 swelling decreased, and she could eat again. Thirteen months later, she remains an outpatient. We recommend HDHAI and radiation therapy to hilar cholangiocellularcarcinoma even if the portal vein is completely obstructed.
authors.affiliation: Dept. of Gastroenterological Surgery, Iseikai Hospital.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Hasuike
authors.forename: Ichiro
authors.initials: I
authors.lastname: Higuchi
authors.forename: Sanae
authors.initials: S
authors.lastname: Hosomi
authors.forename: Akira
authors.initials: A
authors.lastname: Ishikawa
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Akiyama
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tanigawa
authors.forename: Atsuya
authors.initials: A
authors.lastname: Okada
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use*; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D059248:Chemoradiotherapy; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000628:therapy*; D004322:Drainage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use*; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D011169:Portal Vein / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil