INTERVENTIONAL RADIOLOGY AND RADIOTHERAPY FOR INOPERABLE CHOLANGIOCARCINOMA OF THE EXTRAHEPATIC BILE-DUCTS

Aims and background: To evaluate the effectiveness of external radiati on therapy (ERT), alone or combined with endoluminal brachytherapy (BR T), following percutaneous transhepatic biliary drainage (PTBD) in the treatment of patients affected by inoperable cholangiocarcinoma. Meth ods & study design: From September 1980 to June 1996, 130 jaundiced pa tients affected by inoperable cholangiocarcinoma were submitted to PTB D at the Division of Radiology C of the National Cancer Institute of M ilan. Nineteen were excluded from the present analysis due to the shor t survival after PTBD (<30 days). The other 111 patients were divided Into three groups according to the following therapy: no further treat ment after palliative PTBD in 89 patients (80%, group 1); ERT in 10 pa tients (9%, group 2); ERT plus BRT in 12 patients (11%, group 3). All the ERT+BRT patients were enrolled after 1990 and were treated with hi gh-energy photon beams followed by endobiliary insertion of one or two iridium-192 wires. Results: Median overall survival among the 111 ass essable patients was 126 days; for groups 1, 2 and 3 it was 108, 345 a nd 428 days, respectively. The patients submitted to radiotherapy (ERT alone or ERT+BRT) were evaluated by radiologic examinations after the end of radiation. In group 2, a partial remission in 3 cases, a progr ession of disease in 1 case, and no change in 6 cases were observed. A mong the patients of group 3, complete remission in 5 and partial remi ssion in 7 patients were achieved. in all the patients achieving compl ete remission, the PTBD could be removed. Conclusions: The combination of ERT plus BRT improves survival and quality of life of the patients submitted to PIED for cholangiocarcinoma. Under the technical point o f view, radiation treatment is easy to perform, but much caution is re quired in defining clinical and planning target volumes. Moreover, dra inage during the radiation treatment has to be submitted to a very met iculous surveillance.