EXTERNAL RADIOTHERAPY FOR BILIARY DECOMPRESSION OF HILAR CHOLANGIOCARCINOMA

Obstructive jaundice due to hilar cholangiocarcinoma is difficult to d ecompress because of the location of the tumor. We used external radia tion alone for biliary decompression and reviewed its efficacy in this study. Subjects comprised 14 patients diagnosed as having inoperable hilar cholangiocarcinoma by ultrasonography, percutaneous transhepatic cholangiography, and CT scanning. The total bilirubin level on admiss ion ranged from 0.4 to 34.6 mg/dl (mean: 11.0 mg/dl). These patients w ere irradiated with a 4MeV linear accelerator using parallel opposing fields measuring from 7X7cm to 8X10cm. The total radiation dose ranged from 50 Gy to 60 Gy and in fractions of 1.8-2.0 Gy per day. No patien t underwent further biliary decompression after percutaneous transhepa tic cholangiography, and irradiation was performed immediately after d iagnosis. Eleven of the 14 patients received the full dose of external radiation. Three patients discontinued radiotherapy because of severe vomiting and nausea, pneumonia. and a hemorrhagic gastric ulcer, in 1 0 of the 11 patients, the serum total bilirubin level returned to norm al (p<0.005) and no cholangitis occurred. Obstructive jaundice recurre d in one patient, and serum total bilirubin returned to normal again a fter further irradiation. Eight of the 11 patients could be discharged from hospital and returned to society. The survival time of the 11 pa tients ranged from 3 to 25 months and the 12-month survival rate was 5 0% (Kaplan-Meier method). This study suggests that external radiation therapy is an effective treatment for biliary decompression in patient s with unresectable hilar cholangiocarcinoma.