INTRALUMINAL BRACHYTHERAPY IN BILE-DUCT CARCINOMAS

Background: Cholangiocarcinoma of the biliary tract is a rare tumour w hich has been treated with surgery, radiotherapy, chemotherapy. bypass procedures and stenting, Surgery remains the only curative treatment fur these tumours, but a large proportion are unresectable. Intralumin al brachytherapy has been reported as an effective treatment for local ized cholangiocarcinoma of the biliary tract. The purpose of our study was to analyse the survival of patients with biliary tract carcinoma treated with iridium-192 brachytherapy. Methods: A retrospective revie w of patients treated at Peter MacCallum uas undertaken. From 1989 to 1994, 16 patients underwent brachytherapy via a transhepatic approach for cholangiocarcinoma. There were 12 male and four female patients. T he median age was 65 (range 40-83). All patients had cholangiocarcinom a. Prior treatment included complete resection in three, partial resec tion in one, bypass procedures in eight, endoscopic stents in five and external biliary drainage in 15 of the 16 patients. One patient had r eceived external beam irradiation. Results: The median survival was 23 months and 61% survived 1 year. The most common acute complication wa s cholangitis seen in four patients and the most common late complicat ions were duodenal ulcer seen in two patients and cholangitis seen in two patients. Conclusions: We conclude that iridium-192 brachytherapy is a safe effective treatment for biliary tract carcinoma but a compar ison between surgery and stenting would be of value. However, the cost of brachytherapy is not cheap and its value in this regard should be carefully analysed.