Intraoperative radiotherapy for resectable extrahepatic bile duct cancer

Purpose: Through a retrospective study of intraoperative radiation therapy (IORT) in bile duct cancer, we hope to help clarify its clinical usefulness . Methods and Materials: Between 1976 and 1996, IORT was carried out in 35 pa tients with bile duct cancer at the Tokyo Metropolitan Komagome Hospital. O f the 35 patients, resection proved to be curative in 15. Intraoperative ir radiation of 15-30 Gy (average 20.1 Gy) was delivered by electron beam in t he 5- to 19-MeV energy ranges. Postoperative external-beam radiation therap y (EBRT) was also delivered in 16 patients. The EBRT was fractionated to 2 Gy/day, in principle, and was delivered at 8.8-54 Gy (average 40.4 Gy) by 1 0-MV X-rays. Results: The median survival in our patients was 19 months. The 1-year, 2-y ear, and 5-year survival rates were 57%, 43%, and 19%, respectively. Statis tical analysis identified the following prognostic factors: performance sta tus, curative surgical resection, lymph node metastasis, IORT dosage, and t reatment period. Only 1 patient (3%) died within 30 days after surgery, and the incidence of late-onset complications was 21%. Conclusion: The combination of IORT and EBRT is useful for patients with bi le duct cancer who undergo noncurative resection or who have lymph node met astasis. (C) 1999 Elsevier Science Inc.