Intraluminal brachytherapy and selfexpandable stents in nonresectable biliary malignancies - The question of long-term palliation

Background/Aims: To evaluate the effect of a combination of intraluminal br achytherapy and metallic stent implantation in the treatment of patients wi th nonresectable biliary tumors. Methodology: Thirty-two patients aged 41-80 years with nonresectable biliar y malignancies - Klatskin's tumor (n = 17), gallbladder carcinoma (n = 11) and carcinoma of papilla Vateri (n = 4) - were treated with a combination o f intraluminal brachytherapy (source Ir192, high-dose radiation regimen, to tal dose 30Gy) and metallic stent implantation. Intraluminal brachytherapy and stent insertion (metallic, spiral-Z stent) were performed percutaneousl y in all patients. Results: The mean survival in patients with Klatskin's tumor was 457 days ( range: 64-1186; median: 358 days), in patients with gallbladder carcioma 23 7 days (range: 92-609; median: 210 days) and in patients with carcinoma of papilla Vateri 850 days (range: 48-1518; median: 1277 days). The rate of 2- year survival in these groups was 27, 0 and 50%, respectively. The survival time differed significantly at the 5% level. The mean time of stent patenc y was 418, 220 and 850 days, respectively. No complications related directl y to intraluminal brachytherapy were observed. Conclusions: Intraluminal brachytherapy combined with stent implantation is a safe method and appears to prolong survival in inoperable patients with Klatskin's tumor and carcinoma of papilla Vateri compared with nontreated p atients in previous studies. In contrast no similar effect should be expect ed in patients with gallbladder carcinoma.