INTRALUMINAL BRACHYTHERAPY IN THE TREATMENT OF PANCREAS AND BILE-DUCTCARCINOMA

Purpose: A new method of palliation of malignant obstructive jaundice is presented. Methods and Materials: Twelve patients with carcinoma of the extrahepatic bile duets (EHBD-five patients) or pancreatic head ( PH-seven patients) received radiation therapy between 1988 and 1991. P ercutaneous transhepatic biliary drainage was performed in four EHBD p atients and an endoprosthesis was placed during endoscopic retrograde cholangiopancreatography (ERCP) in the other eight patients. All 12 re ceived intraluminal brachytherapy (ILBT): 20-50 Gy calculated at 1 cm from the Iridium-192 (Ir-192) wire. Fn four PH patients the source was placed in the duct of Wirsung; in the other eight patients ILBT was p erformed via the common bile duct. Five of the seven PH patients and o ne of the five EHBD patients received External Beam Radiation Therapy (EBRT): 26-50 Gy, alone or with concomitant 5-Fluorouracil (5-FU). Res ults: Cholangitis occurred in six patients. Three PH patients treated with EBRT + ILBT developed gastrointestinal toxicities. With a minimum follow-up of 18 months, median survival times were 14 months (EHBD) a nd 11.5 months (PH); one of the seven PH patients is alive (29 months) and two of the EHBD patients are alive (18 and 43 months). All patien ts had satisfactory control of jaundice. Conclusions: The results in t he EHBD patients suggest that the addition of ILBT after biliary drain age prolongs survival. Further experience is necessary to determine wh ether ILBT in the common bile duct and/or in the duct of Wirsung may b e, in PH patients, an alternative boost technique to Interstitial Brac hytherapy (IBT) or Intraoperative Electron Beam Radiation Therapy (IOE BRT).