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Combination of external beam irradiation and high-dose-rate intraluminal brachytherapy for inoperable carcinoma of the extrahepatic bile ducts

Authors
 Hyun Soo Shin  ;  Jinsil Seong  ;  Gwi Eon Kim  ;  Chang Ok Suh  ;  Kyung Ran Park  ;  Kang Kyu Lee  ;  Ik Jae Lee  ;  Sun Rock Moon  ;  Hyung Sik Lee  ;  Woo Chul Kim 
Citation
 INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, Vol.57(1) : 105-112, 2003 
Journal Title
 INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 
ISSN
 0360-3016 
Issue Date
2003
MeSH
Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms/diagnosis* ; Bile Duct Neoplasms/mortality ; Bile Duct Neoplasms/radiotherapy* ; Bile Ducts, Extrahepatic* ; Brachytherapy/methods ; Dose Fractionation, Radiation ; Female ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Neoplasm Recurrence, Local/diagnosis* ; Neoplasm Recurrence, Local/mortality ; Radiotherapy/methods* ; Survival Analysis ; Treatment Outcome
Keywords
Extrahepatic bile duct cancer ; External beam radiotherapy ; Intraluminal brachytherapy ; High-dose-rate
Abstract
PURPOSE: To assess the feasibility and therapeutic benefits of a combination of external beam radiotherapy (EBRT) and high-dose-rate intraluminal brachytherapy (ILBT) for treating patients with inoperable carcinoma of the extrahepatic bile ducts. METHODS AND MATERIALS: Of 31 patients who received RT at the Yonsei Cancer Center, Yonsei University College of Medicine in Seoul, Korea between 1986 and 1995, 17 patients underwent EBRT alone (Group 1) and 14 patients were treated with EBRT in combination with high-dose-rate ILBT (Group 2). After external drainage, EBRT was delivered with a total dose ranging from 36 to 55 Gy (median 50.4) in both groups. High-dose-rate ILBT for the patients in Group 2 was performed using a high-intensity (192)Ir source (Gamma-med remote afterloading system) within the expandable intrabiliary prosthesis (Gianturco stent), inserted transhepatically at the site of the obstruction. The radiation dose of the high-dose-rate ILBT was prescribed at 1.5 cm from the center of the source with a single daily dose of 5 Gy to a total of 15 Gy given in three fractions. The response rate, patterns of treatment failure, treatment morbidity, and survival data in the two groups were compared. RESULTS: Although locoregional recurrence was the most common pattern of failure in both groups, no statistically significant difference was found in the recurrence rates between those who did and did not receive ILBT (53% for Group 1 vs. 36% for Group 2; p > 0.05). However, a prolongation of the median time to tumor recurrence was observed in the Group 2 patients (5 months for Group 1 vs. 9 months for Group 2; p = 0.06). When the EBRT dose delivered was >50 Gy, most patients experienced various degrees of GI symptoms, but the frequency of radiation-induced complications in the two groups was similar. No enhancement in treatment morbidity was attributed to the addition of high-dose-rate ILBT to EBRT. With a median follow-up of 12 months, the overall actuarial 2-year survival rate for Group 2 patients was significantly better than that for Group 1 patients (0% for Group 1 vs. 21% for Group 2; p = 0.015). CONCLUSION: Given these observations, we believe that the combined use of EBRT and high-dose-rate ILBT is a beneficial, relatively safe, and effective method of improving the treatment outcome in selected patients with inoperable carcinoma of the extrahepatic bile ducts.
Full Text
http://www.sciencedirect.com/science/article/pii/S0360301603004103
DOI
10.1016/S0360-3016(03)00410-3
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Gwi Eon(김귀언)
Suh, Chang Ok(서창옥)
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
Lee, Ik Jae(이익재) ORCID logo https://orcid.org/0000-0001-7165-3373
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/114628
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