MALIGNANT BILIARY DUCT OBSTRUCTION - LONG-TERM EXPERIENCE WITH GIANTURCO STENTS AND COMBINED-MODALITY RADIATION-THERAPY

PURPOSE: To evaluate the effect of combined-modality therapy including intraluminal iridium-192 on stent patency and survival in patients wi th malignant biliary obstruction treated with Gianturco stents. MATERI ALS AND METHODS: Twenty-two patients with unresectable biliary obstruc tion caused by cholangiocarcinoma (n = 11) or by secondary extrahepati c bile duct malignant tumors (n = 11) were treated with percutaneous b iliary drainage followed by intraluminal Ir-192 wire placement (mean d ose, 25 Gy) before insertion of Gianturco metal stents. Eleven patient s also received external-beam radiation therapy, and 13 patients recei ved chemotherapy. Patency was defined as absence of jaundice or cholan gitis that necessitated hospitalization, or as seen on hepatobiliary s cans. Survival was determined from the time of stent insertion after b rachytherapy. RESULTS: Patients with cholangiocarcinoma had extended m ean stent patency of 19.5 months (range, 2-46 months) and mean surviva l of 22.6 months (range, 2-72 months). Patients with secondary maligna nt tumors had a mean patency of 4.8 months (range, 1.5-8 months) and a mean survival of 5.3 months (range, 2-9 months). CONCLUSION: Radiatio n therapy including intraluminal Ir-192 appears to extend stent patenc y and survival in patients with inoperable cholangiocarcinoma treated with Gianturco metal stents compared with patients with other extrahep atic bile duct malignant diseases and patients treated without combine d-modality therapy in other studies.