PALLIATION OF IRRESECTABLE HILAR CHOLANGIOCARCINOMA WITH BILIARY DRAINAGE AND RADIOTHERAPY

Twelve patients with irresectable or recurrent hilar cholangiocarcinom a were treated with internal biliary drainage followed by intraluminal (iridium-192) and external-beam radiotherapy. Biliary drainage was ac complished by means of a combined surgical and interventional radiolog ical approach. Initial decompression was performed surgically by resec tion, intrahepatic biliary enteric bypass or distal biliary-enteric an astomosis with a temporary stent. Maintenance of internal biliary drai nage and application of intraluminal radiotherapy were accomplished ra diologically with the use of percutaneous dilatation and metallic expa ndable biliary endoprostheses. Median survival was 14.5 months; all 12 patients survived for at least 6 months. Early complications during r adiotherapy were minor and included two patients with cholangitis and one with transient haemobilia. Jaundice was relieved in ten of 12 pati ents, while episodes of cholangitis were seen during long-term follow- up in II (median 1.5 episodes per patient). Internal biliary drainage, in conjunction with radiotherapy, appears to be safe and effective pa lliation of irresectable or recurrent hilar cholangiocarcinoma, Patien ts can maintain a reasonable quality of life with an acceptable incide nce of cholangitis, without the hindrance of external drainage devices .