Concomitant chemoradiation treatment in the management of patients with extrahepatic biliary tract recurrence of gastric carcinoma

BACKGROUND. The aim of this study was to determine the role of concomitant chemoradiation in the alleviation of obstructive jaundice in patients with extrahepatic biliary tract metastases from gastric carcinoma. METHODS. Thirteen patients with good performance status who had obstructive jaundice resulting from extrahepatic biliary metastases after gastrectomy for gastric carcinoma were treated with palliative intent. Treatment consis ted of insertion of a percutaneous transhepatic choledochal drainage (PTCD) catheter followed by external radiation up to a total dose of 40-60 grays in combination with chemotherapy (cisplatin 20 mg/m(2)/day, 5-fluorouracil 600 mg/m(2)/day, and leucovorin 90 mg/m(2)/day for 96 hours during the firs t and fifth weeks) on an outpatient basis. RESULTS. The concomitant chemoradiation produced a good palliative effect i n all 13 patients. Hyperbilirubinemia continued to improve after treatment, patients' clay-colored stool resolved within an average of 4 weeks (range, 2-6 weeks), and bilirubin levels returned to normal. The PTCD catheter cou ld be removed after treatment was completed (the seventh week); the mean du ration of PTCD placement was 2 months. The entire treatment course was perf ormed on an outpatient basis; hospital admission was necessary only for PTC D insertion and chemotherapy. Ten patients died of their disease, with an a verage survival of 14.4 months (range, 4-31 months) from the time of PTCD i nsertion. Three patients are still alive at 16, 21, and 8 months. Biliary t ract patency was maintained until death. No serious treatment-related compl ications occurred, and no endoprothesis or intraluminal brachytherapy was n eeded in this study. CONCLUSIONS. Satisfactory palliation can be achieved by concomitant chemora diation for patients with obstructive jaundice resulting from extrahepatic biliary metastases from gastric carcinoma, providing an alternative treatme nt choice for these patients. (C) 2000 American Cancer Society.