Intraluminal brachytherapy and selfexpandable stents in nonresectable biliary malignancies - The question of long-term palliation
Abstract
To evaluate the effect of a combination of intraluminal brachytherapy and metallic stent implantation in the treatment of patients with nonresectable biliary tumors. Methodology: Thirty-two patients aged 41-80 years with nonresectable biliary malignancies - Klatskin's tumor (n = 17), gallbladder carcinoma (n = 11) and carcinoma of papilla Vateri (n = 4) - were treated with a combination of intraluminal brachytherapy (source Ir192, high-dose radiation regimen, total dose 30Gy) and metallic stent implantation.
Intraluminal brachytherapy and stent insertion (metallic, spiral-Z stent) were performed percutaneously in all patients. Results: The mean survival in patients with Klatskin's tumor was 457 days (range: 64-1186; median: 358 days), in patients with gallbladder carcioma 237 days (range: 92-609; median: 210 days) and in patients with carcinoma of papilla Vateri 850 days (range: 48-1518; median: 1277 days).
The rate of 2-year survival in these groups was 27, 0 and 50%, respectively. The survival time differed significantly at the 5% level.
The mean time of stent patency was 418, 220 and 850 days, respectively. No complications related directly to intraluminal brachytherapy were observed.
Conclusions: Intraluminal brachytherapy combined with stent implantation is a safe method and appears to prolong survival in inoperable patients with Klatskin's tumor and carcinoma of papilla Vateri compared with nontreated patients in previous studies. In contrast no similar effect should be expected in patients with gallbladder carcinoma.