A RETROSPECTIVE COMPARISON OF ENDOSCOPIC STENTING ALONE WITH STENTINGAND RADIOTHERAPY IN NONRESECTABLE CHOLANGIOCARCINOMA

Background and Aims-Radiotherapy has been reported to be of benefit in prolonging the survival of patients with cholangiocarcinoma. This stu dy examined whether radiotherapy in addition to endoscopic stenting im proved survival, Subjects-56 patients with obstructive jaundice due to histologically confirmed non-resectable cholangiocarcinoma. Methods-A retrospective analysis of these patients who were treated either with endoscopic biliary stenting followed by external beam radiotherapy an d internal iridium-192 brachytherapy (n=28) or with stenting alone (co ntrol group; n=28). Results-The two groups were well matched in age, s ex, acid stricture type. Eighteen patients had a type I stricture (con trol group: 11; radiotherapy group: 7) at the time of diagnosis and 38 had a type II or III stricture (control group: 17; radiotherapy group : 21). The median (range) overall survival from diagnosis was seven (1 -29) and 10 (4-75) months in the control and radiotherapy groups respe ctively: This difference did not reach statistical significance (p=0 . 06), but survival plots indicated a survival advantage in the radioth erapy group in the first nine months after diagnosis. Approximately on e third survived longer than one year in both groups, More patients in the radiotherapy group required a stent change (1 . 9 v 0 . 9: p=0 . 05), and also had a longer overall inpatient stay (42 days v 19: p<0 . 001). When examined on the basis of stricture type, there was a survi val advantage in the first 10 months after diagnosis in those with a t ype II/III stricture (seven and 11 months in the radiotherapy and cont rol groups respectively: 0 . 01<p<0 . 05). There was no difference in survival between the groups in those with a type I stricture. Numbers surviving longer than one year, stent survival, and number of stent ch anges were all similar between the two groups when examined on the bas is of stricture type, but length of hospital stay remained considerabl y longer in all patients receiving radiotherapy. Conclusion-The surviv al advantage of radiotherapy in those with a type II/III stricture is seen only in the first 10 months after diagnosis. The costs of radioth erapy and significantly increased time spent in hospital, however, rai se doubts over Its routine use in the management of non-resectable cho langiocarcinoma