THE ROLE OF RADIATION TREATMENT IN MANAGEMENT OF EXTRAHEPATIC BILIARY-TRACT METASTASIS FROM GASTRIC-CARCINOMA

Purpose: To determine the proper role of radiation treatment in the ma nagement of patients with extrahepatic biliary tract metastasis due to recurrent gastric cancer. Methods and Materials: Twenty patients with malignant biliary obstruction due to recurrent gastric carcinoma afte r gastrectomy were treated with palliative intent at the Yonsei Univer sity College of Medicine from 1986 to 1990. Treatment consisted of ext ernal drainage alone in 11 patients (Group I) and external drainage fo llowed by radiation treatment in nine patients (Group II). Five of nin e patients in Group II underwent external irradiation in combination w ith intraluminal brachytherapy using high dose rate Iridium-192 (Ir-19 2) sources within the expandable intrabiliary prosthesis, a Gianturco stent, inserted transhepatically at the site of obstruction. Results: An excellent local response was observed in five of nine patients in G roup II, in whom biliary patency was restored following treatment so t hat the external drainage catheter could be removed. Prolongation of m edian survival was observed in Group II (9 months) as compared to Grou p I (2 months). There were no serious treatment-related complications with this approach. Conclusion: This treatment approach with external radiotherapy +/- intraluminal brachytherapy could achieve effective pa lliation and improve the quality of life in selected patients with ext rahepatic biliary metastasis from gastric carcinoma.