Six-year recurrence free survival after intraluminal iridium-192 therapy of human bilobar biliary papillomatosis - A case report

BACKGROUND. Biliary papillomatosis is rare and often fatal. Liver resection or transplantation is recommended but may be impossible due to tumor or pa tient factors; furthermore, it appears to the authors of this study that no follow-up results after transplantation have been reported in previous stu dies. METHODS. Bilobar but limited biliary papillomatosis in a man age 54 years w as mapped by cholangiopancreatography, cholecystectomy, and operative chola ngioscopy. After cholangioscopic electrocoagulation, iridium-192 wires were temporarily inserted into the affected bile ducts, giving a dose of 60 gra ys at a 3-mm distance. Another percutaneous cholangioscopic electrocoagulat ion was performed 3 weeks later. RESULTS. The patient has been free of tumor and in good health for 80 month s, but he has a long term stenting of a nonneoplastic stricture at the conf luence of the bile ducts. CONCLUSIONS. Mechanical tumor reduction and intraluminal brachytherapy coul d possibly replace transplantation (which up to now has been suggested but not reported) when this life-threatening disease is bilobar, and also possi bly replace liver resection for limited tumors in patients who are too frai l for surgery. (C) 2000 American Cancer Society.