The Effect of External Radiation Therapy in management of malignanat obstructive Jaundice due to Porta Hepatis metastasis from Stomach Cancer

Yang, Kwang Mo; Kim, Joon Hee; Kim, Chul Soo; Suh, Hyun Suk; Kim, Re Hwe

Abstract

PURPOSE: Since 1983, authors have conducted a study to evaluate the effect of external radiation therapy an to determine affected factors in management of the patients with malignant obstructive jaundice due to porta hepatis metastasis from stomach cancer.
MATERIALS AND METHODS
Thirty two patients with malignant obstructive jaundice due to porta hepatis metstasis from gastric cancer were presented. We have analysed 23 patients who were treated with external radiation therapy of more than 3000 cGy. The radiation dose, disease extent at development of jaundice, total bilirubin levels before radiation therapy, differentiation of histology, combined treatment, intent of primary surgery, initial stage of gastric cancer were analyzed to determine affected factors in radiation therapy. External radiation therapy was delivered with a daily dose of 180-300 cGy. 5 times a week fractionation using 4 MeV linear accelerator. The radiation field included the porta hepatis with tumor mass by the abdominal ultrasonography or CT scan. In twenty three patients received more than 3000 cGy, total irradiation dose was ranged from 3000 cGy to 5480 cGy, median 3770 cGy. Among 23 patients, 13 patients were delivered more than equivalent dose of TDF 65(4140 cGy/23fx).
RESULTS
Among 23 patients, complete, partial and no response were observed in 13, 5, 5 patients, respectively. The median survival for all patients was 5 months. He significant prolongation of median survival was observed in complete responders(11 months) as compared to partial and no responders(5 months, 5 months, respectively). Out of 13 patients with complete response, 6 patients lived more than a year. Among 13 patients received more than 4140 cGy equivalent dose, complete, partial and no response were observed in 10, 2 and 1 patients, respectively. The median survival for all these patients was 9.5 months. The median survival for complete responders(10/13) was 11.5 months. Among 10 patients receiving less than 4140 cGy equivalent dose, complete, partial and no response were observed in 3,3,4 patients, respectively. The median survival for al these patients was 4.3 months. Therefore, the radiation dose affected the results of treatment. For the complete response with prolongation of survival duration, at least 4140 cGy equivalent dose should be delivered to porta hepatis. In evaluation of the disease extent, 7 patients of 13 complete responders showed localized disease in porta hepatis or peripancreatic area, but all patients with partial and no response showed wide extensive disease or persistant disease of primary gastric cancer. Therefore, the patients with the localized disease were the higher probability of complete response and long term survival. This study suggested that the radiation dose and the disease extent at development of jaundice affected in radiation dose and the disease extent at development of jaundice affected in radiation therapy for malignant obstructive jaundice. There were no serious complications related to external radiation therapy.
CONCLUSION
External radiation therapy only could achieve the palliative affect in the patients with malignant obstructive jaundice due to porta hepatis metastasis from stocach cancer. This study suggested that the prolongation of survival duration could be achieved in complete responders and radiation dose, extent of disease affected the results of treatment of malignant obstructive jaundice.