RESUMO
PURPOSE: Cholangiocarcinomas (CCs) are rare and highly malignant cancers. Although there are different treatment protocols for treatment of cholangiocarcinoma, we aimed to investigate a survival rate of patients with unresectable extrahepatic CCs (ECCs) receiving multimodality therapeutic protocol (MTP) (biliary drainage + external beam radiotherapy [EBRT] + brachytherapy and systemic chemotherapy). Similarly, we aimed to identify a relationship between survival time and associated factors in treatment outcome. MATERIAL AND METHODS: This retrospective study was performed on patients with ECC, who were referred to our university hospital between 2012 and 2015, and their imaging were diagnosed as unresectable. Patients underwent MTP including internal-external drainage catheter (F10-12) with insertion under fluoroscopy guidance, EBRT with 25-28 fractions and concurrent chemotherapy using capecitabine (Xeloda) 825 mg/m2 at the days of radiotherapy, followed by brachytherapy (BT) with iridium-192 (192Ir) or cobalt-60 (60Co) sources for 21 Gy in 3 consecutive days. Demographic variables, complications, laboratory tests, imaging findings, and survival time (OS - overall survival after diagnosis; CS - survival after catheter placement) were recorded. RESULTS: A total of 38 patients, with mean SD age = 58.08 (9.80) years, male = 22 (57.9%), were evaluated. According to Bismuth-Corlette classification, 15 (39.5%) were in stage IIIA, 5 (13.2%) were in stage IIIB, 10 (26.3%) were in stage IV, and 8 (21.2%) were undefined. Of those, 21 (55.3%), 15 (39.5%), and 17 (44.7%) were involved with liver parenchyma, great vessels, and regional lymph nodes, respectively. Mean SD of OS was 15.11 (8.10) months (median = 15; 95% CI: 13.25-16.69), and CS was 2-29 months (mean SD = 11.71 (7.29); median = 10; 95% CI: 10.05-13.37). Further analysis revealed a considerable decrease in OS and CS in those with an involvement of liver parenchyma, great vessels, regional lymph nodes, and Bismuth type IV. CONCLUSIONS: Multimodality therapeutic approach in patients with inoperable ECCs could definitely improve their survival time and decrease complications. Survival time is significantly depending on tumor staging, gender, and involvement of liver parenchyma, great vessels, and regional lymph nodes.
RESUMO
Excessive daytime sleepiness (EDS) is relatively frequent in patients with Parkinson's disease (PD), having a prominent burden on patients' quality of life and causing dangerous events such as motor-vehicle accidents. Previous studies have indicated the role of certain neural tracts in the pathophysiology of sleep disturbances, especially in PD patients. We hypothesized that white matter integrity and connectivity might be altered in patients with PD and EDS. Therefore, this study investigated brain white matter microstructure alterations in patients with Parkinson's disease with EDS (PD-EDS) compared to healthy controls and PD patients without EDS (PD-nEDS). Diffusion MRI connectometry was used to carry out group analysis between PD patients with and without EDS and healthy individuals. EDS in PD patients is associated with decreased connectivity in the left and right fornix, left and right inferior longitudinal fasciculus (ILF), left inferior and middle cerebellar peduncles in comparison to PD-nEDS group. These differences between PD-EDS and PD-nEDS patients reflects microstructural changes with respect to sleep-related circuits, which can pave the way for future investigations considering EDS pathogenesis in Parkinson's disease.