BILIARY TREE MALIGNANCIES - THE UNIVERSITY-OF-MINNESOTA EXPERIENCE

Because of its slow-growing natural history, most patients with extrah epatic biliary tree malignancies present with inoperable disease, For the minority of patients with operable disease, surgical resection rem ains the treatment of choice and offers tile patient the best chance f or long-term local control. The role of chemotherapy and radiotherapy in the management of these patients in the definitive, adjuvant, and p alliative setting is expanding, although unsettled, Response rates wit h chemotherapy have been low and will most likely find a place in a co mbined multimodality setting. Radiotherapy (external beam, intraoperat ive, and intraluminal brachytherapy using Ir-192) has played a major r ole in the treatment of these cancers. The close proximity of bowel, k idney, and liver limits the external beam radiotherapy doses that can be safely delivered. Since mast patients require placement of percutan eous transhepatic biliary catheters to relieve jaundice, this route ha s been utilized to deliver higher doses of radiation to the tumor area with intraluminal Ir-192 ribbons. The University of Minnesota has tre ated 15 patients with extrahepatic bile duct cancers. Most were locate d at the bifurcation of the common bile duct and were treated with int raluminal brachytherapy alone or with external beam radiotherapy. Our results are comparable to previously reported retrospective data with a median survival of 8 months and three long-term survivors. (C) 1997 Wiley-Liss, Inc.