Length and quality of survival following external beam radiotherapy combined with expandable metallic stent for unresectable hilar cholangiocarcinoma

Background and Objectives: Hilar cholangiocarcinoma is a morbid disease wit h a poor prognosis because resection cannot be performed in many cases. The purpose of this study was to evaluate whether external beam radiotherapy ( RT combined with expandable metallic biliary stent (EMS) affects the length and quality of survival of patients with unresectable hilar cholangiocarci nomas. Methods: Fifty-one patients with unresectable hilar cholangiocarcinoma were retrospectively reviewed. Thirty patients received external beam radiother apy combined with EMS (EMS+RT group), 10 patients were treated with EMS alo ne (EMS group), and the remaining 11 patients underwent percutaneous transh epatic biliary drainage alone (PTBD group). The length and quality of survi val were analyzed and compared among the 3 groups. Results: The mean survival of 6.4 months in the EMS group was significantly longer than that of 4.4 months in the PTBD group (P < 0.05). The EMS+RT gr oup with a mean survival of 10.6 months had a significantly longer survival than the EMS group (P < 0.05). The average of the monthly Karnofsky scores of 74.9 in the EMS+RT group and 68.1 in the EMS group, as a parameter of q uality of survival, was significantly higher than that of 57.7 in the PTBD group (P < 0.01). The number of hospital days per month of survival was sig nificantly smaller in the EMS+RT and EMS groups than in the PTBD group (10. 4, 14.2 vs. 27.3 days; P < 0.001). The EMS+RT group had a longer stent pate ncy than the EMS group (mean: 9.8 vs. 3.7 months; P < 0.001). Conclusions: These results indicate that external radiotherapy combined wit h metallic biliary endoprosthesis can increase the length and quality of su rvival and consequently provide a definite palliative benefit for patients with unresectable hilar cholangiocarcinoma. J. Surg. Oncol. 2000:75:89-94. (C) 2000 Wiley-Liss, Inc.