The Effect of Combination Intraluminal Brachytherapy and External Beam Radiotherapy for the Treatment of Unresectable Hilar Cholangiocarcinoma

Hur, Chan Young; Kim, Sang Won; Kim, Jin Soo; Kim, Kwang Hee; Park, Jeong Ik; Choi, Chang Soo; Choi, Young Kil

Abstract

PURPOSE: The purpose of this study was to evaluate the effect of combination intraluminal brachytherapy (ILBT) and external beam radiotherapy (EBRT) on patient survival and stent patency after metallic biliary stent placement in patients with unresectable hilar cholangiocarcinoma.
METHODS
We retrospectively analyzed the data of 29 patients with unresectable hilar cholangiocarcinoma who presented between January 2002 and December 2006. Fifteen patients were treated with metallic stents alone (RT (-) group), and 14 patients were treated with ILBT and EBRT after metallic stent placement (RT (+) group). ILBT was performed using a 192Ir source at a dose of 15 Gy in 3 fractions. The EBRT dose was 45 Gy in 25 fractions.
RESULTS
The 1- and 3-year patient survival rates in the RT (+) group were 51.9% and 8.7%, respectively, and those in the RT (-) group were 46.7% and 38.9%, respectively. However, there was no statistically significant difference in the survival rates between the two groups (p=0.38). The 1- and 2-year stent patency rates for the RT (+) group were numerically higher than those in the RT (-) group (74.0%, 74.0%, respectively vs. 59.9%, 39.9%, respectively), but not to a statistically significant degree (p=0.11). The median stent patency was 10 months in the RT (+) group and 8 months in the RT (-) group. All of the stents obstructed at 31 months in the RT (+) group and at 26 months in the RT (-) group. Four patients showed minor complications, including gastrointestinal discomfort and dermatitis after radiation therapy, but all of them responded well to conservative treatment.
CONCLUSION
Although combined ILBT and EBRT for unresectable hilar cholangiocarcinoma was safely carried out after biliary stent insertion with minor complications, it did not have a significant role in improving the survival and stent patency rates.