Korean J Gastroenterol.  2011 Nov;58(5):264-269. 10.4166/kjg.2011.58.5.264.

An Experience of Cyberknife Treatment in Patients with Advanced Pancreaticobilliary Malignancy

• Jung YH
• Choi HS
• Cheon YK
• Moon JH
• Cho YD
• Chang AR
• Won JH

• KMID: 1026368
• DOI: http://doi.org/10.4166/kjg.2011.58.5.264

Abstract

BACKGROUND/AIMS
CyberKnife(TM) stereotactic body radiotherapy (SBRT) has been thought as a promising treatment modality for inoperable or recurred pancreaticobiliary malignancies. But, clinical course of CyberKnife(TM) treatment have not been established yet, so we report the experience of CyberKnife(TM) treatment in 19 patients with recurred or advanced pancreaticobilliary malignancies.
METHODS
Between July 2008 and May 2009, 19 patients (gallbladder cancer 4, common bile duct cancer 5, and pancreatic cancer 10) with recurred (12) and advanced pancreaticobiliary cancer (7) underwent CyberKnife(TM) treatment in Soonchunhyang University Hospital. Tumor size was evaluated at 1, 3, 6, 8 and every 3 months after SBRT.
RESULTS
The mean age was 60.2 years, and the mean size of target lesions was 28.1+/-1.30 mm. After CyberKnife(TM) treatment, the average size of target lesions was decreased; 2.53+/-4.18 mm from months 0-1 in 19 patients, 2.47+/-4.7 mm from months 1-3 in 15 patients, 0.08+/-5.11 mm from months 3-6 in 12 patients. However, the average size of target lesions was increased 3.67+/-8.98 mm from months 6-8 in 6 patients. There were 2 cases of massive duodenal ulcer bleeding after CyberKnife(TM) treatment, one of them expired due to ulcer bleeding. Also, other minor complications appeared such as 1 case of abdominal pain and 1 case of diarrhea.
CONCLUSIONS
CyberKnife(TM) treatment seems to be effective in local control of pancreaticobiliary cancer, but we experienced serious complications. Further prospective studies will be needed for the proper evaluation of role of Cyberknife(TM) treatment in patients with advanced pancreaticobiliary malignancies.

Keyword

Pancreaticobiliary malignancies; Cyberknife SBRT

MeSH Terms

Adult
Aged
CA-19-9 Antigen/analysis
Common Bile Duct Neoplasms/complications/pathology/*surgery
Female
Gallbladder Neoplasms/complications/pathology/*surgery
Gastrointestinal Hemorrhage/etiology
Humans
Male
Middle Aged
Pancreatic Neoplasms/complications/pathology/*surgery
Radiosurgery
Retrospective Studies
Tomography, X-Ray Computed

Figure

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  Fig. 1. CT findings. (A) CT scan revealed 2.9 cm sized metastatic lymph node in portocaval space (arrow). (B) Follow up CT scan after 6 months of CyberKnife TM therapy showed nearly complete resolution of metastatic lymph node (arrow).

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  Fig. 2. Treatment response of CyberKnife TM therapy in 12 patients.

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  Fig. 3. Response related to target organ in 12 patients. L/N, lymph node; GB, gallbladder; Post OP, postoperative; CBD, common bile duct.

Reference

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