EXTERNAL RADIATION-THERAPY AND TRANSCATHETER IRIDIUM IN THE TREATMENTOF EXTRAHEPATIC BILE-DUCT CARCINOMA

Purpose/Objective: Review survival, prognostic factors, and patterns o f failure in patients with extrahepatic bile duct (EHBD) carcinoma tre ated with external beam irradiation (EBRT) and transcatheter iridium, Methods and Materials: The charts of 24 patients with EHBD cancer trea ted with EBRT and transcatheter boost were reviewed. All patients had transhepatic biliary tubes or endoprostheses placed, Two patients unde rwent hemihepatectomy with hepaticojejunostomy formation but had resid ual disease. Two patients had biopsy proven adenopathy, Five patients had Grade 1 adenocarcinoma, nine Grade 2, six Grade 3, and one Grade 4 disease, Median EBRT dose was 50.4 Gy delivered in 1.8 Gy/day fractio ns, Median transcatheter boost at 1 cm radius was 20 Gy, Nine patients received concomitant 5-Fluorouracil (5-FU) during EBRT, Results: Medi an survival was 12.8 months (range 7.5 months to 9 Sears), Overall 2- and 5-year survival rates were 18.8 and 14.1%, respectively (three dis ease-free survivors greater than or equal to 5 years), One patient is still alive without relapse 10 Sears from diagnosis and 5 years after liver transplantation for liver failure (no cancer in specimen, underl ying sclerosing cholangitis), Two additional long-term survivors had n o evidence of relapse 6.9 and 8.2 years after diagnosis, Histologic gr ade, lymph node status, cystic, hepatic, common hepatic or common bile duct involvement, surgical resection, radiation therapy dose, and che motherapy did not significantly effect survival due to the number of p atients analyzed. There was a trend towards improved survival with the addition of 5-FU chemotherapy (5-year survival in two of nine patient s, or 22%). Eight of 24 patients (33%) demonstrated radiographic evide nce of local recurrence. Distant metastases developed in 6 of 24 (25%) patients, The most common complications were tube related cholangitis (50%) and gastric/duodenal ulceration or bleeding (42%), Conclusion: External beam irradiation combined with a transcatheter boost can resu lt in long-term survival of patients with EHBD cancer, Both distant me tastases acid local recurrence develop in 25-30% of patients despite i rradiation, Survival may be improved by using chemotherapy in combinat ion with EBRT to impact disease relapse (local and distant), Because t here may be a dose response with irradiation, survival may also be imp roved by increasing the dose of radiation delivered by transcatheter b oost, A Phase II trial is being developed using a combination of 45-50 Gy EBRT with concomitant 5-FU delivered by protracted venous infusion followed by a 25-30 Gy transcatheter boost, (C) 1997 Elsevier Science Inc.