COMBINED EXTERNAL-BEAM RADIOTHERAPY AND INTRALUMINAL HIGH-DOSE-RATE BRACHYTHERAPY ON BILE-DUCT CARCINOMAS

Purpose: The aim of this study was to investigate the effectiveness an d complications of combined external beam and intraluminal high dose r ate irradiation and various adjuvant biliary drainage techniques on pa tients with bile duet carcinomas. Methods and Materials: Eighteen pati ents with carcinomas of the hepatic duct bifurcation and 12 patients w ith carcinomas of the choledochus duct or the common hepatic duct were treated with combined external beam radiotherapy and intraluminal hig h-dose rate brachytherapy. Nine patients received radiotherapy after p alliative tumor resection and 21 patients were primarily irradiated. T wenty-five patients completed the full course of radiotherapy. On thes e patients, the reference doses for the external beam varied from 30 t o 45 Gy and for brachytherapy from 20 to 45 Gy. Biliary drainage after radiotherapy was achieved either with percutaneous catheters, endopro sthesis, or stents. Results: The median survival for the entire group was 10 months. The actuarial survival was 34% after 1 year, 18% after 2 and 3 years, and 8% after 5 years. The subgroup with palliative tumo r resection exhibit a significantly better survival (median: 12.1 mont hs vs. 7.9 months). Three patients are still living without evidence o f disease since 35 to 69 months. Major complications like bacterial ch olangitis could be lowered from 37% to 28% through exchange of percuta neous transhepatic catheters to endoprosthesis or stents. The longest lasting drainages were achieved through stents. The frequency of radio genic ulcera were lowered from 23% to presently 7.6% after the total d ose of the high dose rate afterloading boost was reduced to 20 Gy. Con clusions: The present standard treatment schedule 40 Gy for the extern al beam and 20 Gy (fourfold 5 Gy) for the afterloading boost seems to be appropriate and well tolerated. After radiotherapy, a permanent sup ply of drainage should be made with a stent.