ROLE OF INTRALUMINAL BRACHYTHERAPY IN EXTRAHEPATIC BILE-DUCT AND PANCREATIC CANCERS - IS IT JUST FOR PALLIATION

PURPOSE: To evaluate intraluminal brachytherapy (ILBT) in patients wit h extrahepatic bile duct or pancreatic cancers. MATERIALS AND METHODS: Thirty-one patients (aged 33-87 years) with unresectable extrahepatic bile duct (n = 18) or pancreatic (n = 13) cancer received ILBT exclus ively or as part of a definitive treatment regimen. ILBT was performed with transhepatic percutaneous drainage in four patients and with end oscopic retrograde cholangiopancreatography in 27. Fourteen patients w ith no metastases, an Eastern Cooperative Oncology Group performance s core of less than or equal to 2, and good hematologic parameters recei ved combined modality treatment: 30-Gy ILBT and 45-Gy external-beam ra diation therapy with continuous infusion of fluorouracil. Seventeen pa tients underwent 50-Gy ILBT alone for palliation. RESULTS: No direct t reatment-related acute toxic reactions were seen. Three patients had c holangitis early in the study. Three patients had late gastrointestina l bleeding. Jaundice was palliated in all patients (n = 29); pain, in 11 of 13 patients. The survival rate in patients with extrahepatic bil e duct cancer was 62% (five of eight) at 2 years for combined modality treatment. No patient with pancreatic cancer lived for longer than 2 years. CONCLUSION: ILBT is an effective palliative treatment of unrese ctable extrahepatic bile duct and pancreatic cancers. Results suggest a possible ''curative'' role in specific clinical settings when proper ly integrated with other treatments.