Preliminary clinical study of biliary tract irradiation stent for hilar cholangiocarcinoma with malignant obstructive jaundice / 中国介入影像与治疗学

Objective To evaluate the efficacy and safety of biliary stent loaded with 125I seeds in treatment of hilar cholangiocarcinoma with malignant obstructive jaundice.Methods Totally 43 patients with malignant obstructive jaundice caused by cholangiocarcinoma were included.All the patients underwent percutaneous transhepatic puncture of the left and right side branch of the bile duct.In the hilar stenosis,the biliary stent with 125I seeds were implanted,and the biliary drainage tube had been kept in 3 to 5 days after procedures.The drainage tube was removed and the puncture road was closed after the patency of stents were confirmed by cholangiography.The changes of liver function before and after procedures were recorded,and the survival time was observed.Results Five biliary stents loaded with 125I seeds were implanted in type I (n=5),36 in type Ⅱ (n=18),8 in type Ⅲ (n=4) and 25 in type Ⅳ (n=16).The serum total bilirubin and direct bilirubin of patients before procedures were (145.54 ± 65.35) μmol/L and (124.73 ± 35.04) μmol/L,respectively,and (65.91±29.43)μmol/L and (35.50±15.12)μmol/L respectively after procedures.Compared with preoperative,the total bilirubin,direct bilirubin,alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,C-reactive protein and gamma glutamic transaminase decreased significantly (all P＜0.05).The lactate dehydrogenase had no significant difference before and after operation (P=1.050).The median survival time was 13 months (3.0 to 22.5 months).The serious complications such as biliary puncture,pancreatitis,severe biliary tract infection or biliary bleeding were not occurred.Conclusion Biliary stent loaded with 125 I seeds is an effective therapy to alleviate symptoms of jaundice and prolong the survival time of patients with malignant obstructive jaundice caused by hilar cholangiocarcinoma.

High-Dose-Rate Intraluminal Brachytherapy for Biliary Obstruction by Secondary Malignant Biliary Tumors / 대한방사선종양학회지

PURPOSE: To analyze the survival period, prognostic factors and complications of patients having undergone high-dose-rate intraluminal brachytherapy (HDR-ILB) as a salvage radiation therapy, while having a catheter, for percutaneous transhepatic biliary drainage (PTBD), inserted due to biliary obstruction caused by a secondary malignant biliary tumor. METHODS AND MATERIALS: A retrospective study was performed on 24 patients having undergone HDR- ILB, with PTBD catheter insertion, between December 1992 and August 2001. Their median age was 58.5, ranging from 35 to 82 years. The primary cancer site were the stomach, gallbladder, liver, pancreas and the colon, with 12, 6, 3, 2 and 1 cases, respectively. Eighteen patients were treated with external beam radiation therapy and HDR-ILB, while six were treated with HDR-ILB only. The total external beam, and brachytherapy radiations dose were 30~61.2 and 9~30 Gy, with median doses of 50 and 15 Gy, respectively. RESULTS: Of the 24 patients analyzed, 22 died during the follow-up period, with a median survival of 7.3 months. The 6 and 12 months survival rates were 54.2 (13 patients) and 20.8% (5 patients), respectively. The median survivals for stomach and gallbladder cancers were 7.8 and 10.2 months, respectively. According to the univariate analysis, a significant factor affecting survival of over one year was the total radiation dose (over 50 Gy) (p=0.0200), with all the patients surviving more than one year had been irradiated with more than 50 Gy. The acute side effects during the radiation therapy were managed with conservative treatment. During the follow-up period, 5 patients showed symptoms of cholangitis due to the radiation therapy. CONCLUSION: An extension to the survival of those patients treated with HDR-ILB is suggested compared to the median historical survival of those patients treated with external biliary drainage. A boost radiation dose could be effectively given, by performing HDR-ILB, which is a prognostic factor. In addition, the acute complications of radiation therapy were effectively controlled by conservative management, and it could be regarded as a safe treatment.

The Role of Intraluminal Brachytherapy in Management of Esophageal Cancer / 대한치료방사선과학회지

PURPOSE: To evaluate our clinical experience with the combination of teletherapy and intraluminal brachytherapy in patients with unresectable or inoperable esophageal cancers. MATERIALS AND METHODS: From Nov. 1989 to Mar. 1993, twenty patients with esophageal cancer were treated with radical radiotherapy and intraluminal brachytherapy at Yonsei Cancer Center. All patients had squamous histology and stage distribution was as follows: stage II, 4(20%) patients; III, 15(75%) patients; IV, 1(5%) patients. A dose of 5-12 Gy/1-3 weeks with intraluminal brachytherapy (3-5 Gy/fraction) to 5mm from the outside of the esophageal tube using high dose rate iridium-192 reotely afterloading bracytherapy machine was given 2 weeks after a total dose of 59-64Gy with external radiotherapy. Induction chemotherapy using cisplatin and 5-FU was performed in 13 patients with median 3 cycles(1-6 cycles). Response rate, local control rate, survival and complications were analysed retrospectively. RESULTS: Two-year overall survival rate and median survival were 15.8% and 13.5 months. Resonse rates were as follows: complete remission(CR) 5(25%); partial remission a(Pra) 7(35%); partial remission b(PRb) 7(35%); no response(NR) 1(5%). Patterns of failure were as follows : local failure 13(65%), local and distant failure 3(15%), distant failure 0(0%). Ultimate local control rate was 20%. Treatment related complications included esophageal ulcer in two patients and esophageal stricture in one. CONCLUSION: Though poor local control rate, median survival was improved as compared with previous results of radiation therapy alone(8months) and chemo-radiation combined treatment(11months) in Yonsei Cancer Center. High-dose-rate intraluminal brachytherapy following external irradiation is an effective treatment modality with acceptable toxicity in esophageal cancer.

Optimization of Dose Distribution for High Dose Rate Intraluminal Therapy / 대한치료방사선과학회지

The use of high dose rate remote afterloading system for the treatment of intraluminal lesions necessitates the need for a more accurate of dose distributions around the high intensity brachytherapy sources, doses are often prescribed to a distance of few centimeters from the linear source, and in this range the dose distribution is very difficult to assess. Accurated and optimized dose calculation with stable numerical algorithms by PC level computer was required to treatment intraluminal lesions by high dose rate brachytherapy system. The exposure rate from sources was calculated with Sievert integral and dose rate in tissue was calculated with Meisberger equation. An algorithm for generating a treatment plan with optimized dose distribution was developed for high dose rate intraluminal radiotherapy. The treatment volume becomes the locus of the constrained target surface points that is the specified radial distance from the source dwelling positions. The treatment target volume may be alternately outlined on a x-ray film of the implant dummy sources. The routine used a linear programming formulism to compute which dwell time at each position to irradiate the constrained dose rate at the target surface points whiles minimizing the total volume integrated dose to the patient. The exposure rate and the dose distribution to be confirmed the result of calculation with algorithm were measured with film dosimetry, TLD and small size ion chambers.

Intraluminal brachytherapy in treatment of malignant obstructive jaundice / 介入放射学杂志

Objective To study the practicability and preliminary effect of intraluminal brachytherapy in treatment of malignant obstructive jaundice.Methods Intraluminal brachytherapy was performed in 4 patients who had been treated with biliary stent implantation. Results No complications related to intraluminal brachytherapy had happened.One patient was followed up by means of CT,showing reduction in tumor size. Conclusion Intraluminal brachytherapy is a safe and effective method in treating malignant tumor causing obstructive jaundice.

INTRALUMINAL BRACHYTHERAPY IN LOCO-REGIONAL RECURRENT ADVANCEDESOPHAGEAL CARCINOMA / 中华放射肿瘤学杂志

From May 1990 January 1991, 22 patients with recurrent esophageal carcinoma after external radiotherapy were treated by intraluminal brachytherapy of Iridium-192(HDR). Preliminary results showed relief of symptoms and improvment of general condition with gain weight. Barium X-ray films revealed better barium passage and smooth mucosa in 80% patients. 14 cases have survived over 8 months and 2 over 16 months. The average survival was 9.18 months.

The Role of Radiotherapy in the Treatment of Extrahepatic Bile Duct Carcinoma / 대한치료방사선과학회지

Twenty-seven patients with unresectable extrahepatic bile duct carcinoma (n=21) or with microscopic evidence of tumor rest after aggressive surgery for extrahepatic bile duct carcinoma(n=6) between 1985 and 1990 were given radiotherapy consisting intentionally external radiotherapy and /or intraluminal therapy using Gamma-Med 12i (192-lr) high dose rate (HDR) remote control afterloading system following bile drainage procedures and Gianturco stent insertion. The objectives of this study has been to assess the feasibility and effects on survival of a combination of external radiotherapy and brachytherapy with which we hope to achieve optimal loco-regional control for patients with unresectable extrahepatic bile duct tumors. Sixteen patients were men and deleven were women, and the mean age was 58 years (34-70). 10MV X-ray was used for radiation therapy, with the total dose ranging from 45 Gy to 55 Gy, and intraluminal brachytherapy performed after external radiotherapy, with the dose of total 15 Gy. The minimum follow up was 12 months. Failure were predominantly local-regional, without distant failure. Median survival was 10 months; 2-year actuarial survival rates was 21%. Median survival for common hepatic duct(CHD) cancer was 9 months; for common bile duct (CBD) cancer, was 16 months. And median survival for incomplete surgery/external radiotherapy group and external/intraluminal radiotherapy group was 10 months; for external radiotherapy alone group, was 6 months. Use of chemotherapy and/or hyperthermia were not affected in survival. Therefore, our result is that the survival rates in the group of external/intralumial radiotherapy were comparable with ones in the group of incomplete resection/external radiotherapy, andso we believe that the aggressive local and regional radiotherapy can improve the quality of life and the survival length