Chemoradiation May Prolong Survival of Patients with Non-Bulky Unresectable Extrahepatic Biliary Carcinoma

PURPOSE:. This study compared stenting and chemoradiation (CRT) and attempted to identify factors that are predictive of response to CRT. MATERIAL AND METHODS:. A retrospective analysis identified 98 patients treated. The primary tumor and lymphatics received 45 Gy of three-dimensional conformal radiotherapy. Tumors were boosted to a median total dose of 50.8 Gy. Simultaneous chemotherapy was 5-fluorouracil- (5-FU) and gemcitabine-based. RTOG/NCI-CTC toxicity criteria were applied. RESULTS:. Median survival time was 11.8 months for all patients, 9.3 months for patients with stenting alone and 16.5 months with CRT (p = 0.22). Only tumor diameter was predictive of survival for treatment with CRT. A threshold of 40 mm at diagnosis distinguished two survival profiles (21.4 vs. 8.7 months; p = 0.01). Toxicity was lower for 5-FU-based CRT compared to gemcitabinebased CRT, but a safe schedule for gemcitabine-based CRT was identified. Two patients (2/25) with unresectable tumors at diagnosis had pathohistological complete response at resection after CRT. CONCLUSION:. Inclusion criteria for future CRT trials should be based on tumor size at diagnosis: patients otherwise eligible for CRT should only be included with an inoperable tumor 相似文献   

Arterio-biliary fistula as rare complication of chemoradiation therapy for intrahepatic cholangiocarcinoma

Significant hemobilia due to arterio-biliary fistula is a very rare complication of chemoradiation therapy (CRT) for unresectable intrahepatic cholangiocarcinoma (ICC). Here we report a case of arterio-biliary fistula after CRT for unresectable ICC demonstrated by angiographic examinations. This fistula was successfully treated by endovascular embolization. Hemobilia is a rare complication, but arterio-biliary fistula should be considered after CRT of ICC.     

肝门部胆管癌治疗方法演变与预后

目的探讨肝门部胆管癌治疗方法的变化及效果。方法回顾分析1990年1月─2009年8月收治的198例肝门部胆管癌的临床特点、诊断、分期、治疗方式及随访结果。结果梗阻性黄疸仍为肝门部胆管癌的首发临床表现,肝门部CT及核磁胆道成像（MRCP）均为诊断的有效方法 ,阳性率高。肿瘤分期：2000年以前（A组）和2000年以后（B组）病例进行比较,BismuthⅠ期病例数较前增加不明显;BismuthⅡ、Ⅲ期为主要病例,且病例数有明显增加;BismuthⅣ期则相反,病例数有所减少,但无统计学意义（P〉0.05）。治疗中,49例患者采取非手术内外引流;手术的149例中,单纯引流24例,手术探查＋胆肠吻合51例,姑息性局部切除42例,胆管癌切除＋肝部分切除30例,肝移植2例。按照时间节点分析,A组61例手术中手术切除率为34.4%（21/61）,且以姑息性切除为主（16例）;B组88例手术中手术切除率为60.2%（53/88）,其中姑息性切除与根治性切除分别为26例和27例,两组比较有统计学意义（P〈0.05）。A组仅8例行局部放疗,B组中89例行局部聚焦放疗。从治疗效果分析,非手术内外引流及手术内外引流效果均不好,5年生存为个案。手术切除患者中,BismuthⅠ、Ⅱ期生存率最高,5年生存率83.3%（10/12）;BismuthⅢ期手术切除效果好于非手术治疗;BismuthⅣ期手术切除与否效果均不好,两组手术切除后的预后无统计学意义（P〉0.05）。手术结合术后放疗（γ刀）可在一定程度上延长患者生存时间。影响患者预后的主要因素为肿瘤复发转移,其中局部淋巴结转移与肝内广泛转移最为多见。结论肝门部胆管癌Ⅰ期的诊断并未因为CT和MRI应用而提高,中期BismuthⅡ、Ⅲ期较前例数有所增多,晚期患者相对下降。手术切除率较前有所提高,根治性与姑息性切除均有利于延长患者生存时间,手术切除结合局部放疗可在一定程度上延长患者生命。影响患者长期存活的主要原因仍旧是肿瘤的局部与肝内广泛转移,更加有效的治疗手段有待进一步研究。     

Adenocarcinoma of the oesophagus: neoadjuvant chemoradiation and radical surgery

Purpose

To retrospectively evaluate long-term treatment results following neoadjuvant chemoradiation (CRT) and radical surgery in patients with advanced adenocarcinoma (AC) of the oesophagus.

Patients and methods

Between 2005 and 2015, a total of 102 consecutive patients with a median age of 64 years (range, 44–86 years) and AC of the oesophagus were evaluated of whom 84 received a full CRT. A group of 51 patients was treated with neoadjuvant intent followed by radical surgery. A total dose of 50.4?Gy with mostly weekly paclitaxel/fluorouracil chemotherapy was administered. Six to eight weeks following CRT, a transthoracic subtotal oesophageal and proximal gastric resection was performed. Survival curves for overall survival and no evidence of disease (NED) survival (primary endpoints) were calculated according to Kaplan–Meier, and possible prognostic factors were evaluated by the log-rank test as well as by a Cox regression analysis.

Results

Median follow-up time of the surviving patients was 48 months (range, 14–134 months). Overall and NED survival rates for patients of the study group (n?=?51) were 40 and 32%, respectively, at 5 years. Age (p?=?0.04), ypT category (p?=?0.1) and the development of distant metastases (p?=?0.05) were identified as (marginally) independent prognostic variables with impact on survival. Median survival time for patients of the study group (n?=?51) was 45?±?18 months (95%CI 9–81 months). Clear resection margins were achieved in 46/51 patients (92%). Regression rates with complete regression rare residual cancer and increased number of residual cells, but predominantly fibrosis were 33, 41, and 10%, respectively. Patterns of failure revealed local with distant recurrence in 2/51 (4%), regional recurrence alone in 2/51 (4%), and distant metastases in 27/51 (53%) patients.

Conclusion

Neoadjuvant CRT in patients with AC of the oesophagus followed by thoracoabdominal surgery is a locally very effective concept. A significant tumour regression in almost 75% of the patients may stimulate prospective trials on the omission of radical surgery for some elderly patients. Due to a high rate of distant metastases further investigations in terms of effective systemic therapy may be warranted.

     

肝门胆管癌三维适形放疗联合卡培他滨同步化疗效果评价

目的 回顾性评价三维适形放疗联合卡培他滨同步化疗治疗非手术肝门部胆管癌的疗效和不良反应.方法 对19例不符合手术指征的肝门胆管癌患者行三维适形放疗联合卡培他滨同步化疗,放疗2Gy/次,5次/周,计划照射50 Gy/25次.放疗第1天开始口服卡培他滨,早1 g,晚2 g.结果 12例（63.2%）达部分缓解（partial remission,PR）,7例（36.8%）达稳定（stable disease,SD）.中位生存期12.7个月（4.3～ 20.8个月）,中位无病生存期9.3个月（3.6～18.6个月）.3例（15.8%）发生3级毒性反应,无4级毒性反应.结论 三维适形放疗联合卡培他滨同步化疗对肝门胆管癌非手术治疗有效,且安全.     

Transcatheter arterial chemoembolization in unresectable cholangiocarcinoma: initial experience in a single institution

PURPOSE: Unresectable cholangiocarcinoma carries a dismal prognosis, with median survival times ranging from 6 to 12 months from the time of diagnosis. Palliative therapies have been disappointing and have not been shown to significantly prolong survival. Conversely, transcatheter arterial chemoembolization (TACE) has been effective in prolonging the lives of patients with hepatocellular carcinoma but has not been used against cholangiocarcinoma. Therefore, the purpose of the present study was to assess the safety and efficacy (ie, survival) of TACE in patients with unresectable intrahepatic cholangiocarcinoma. MATERIALS AND METHODS: Seventeen patients with unresectable cholangiocarcinoma were treated with one or more cycles of TACE between 1995 and 2004 at our institution. Follow-up imaging was performed on all patients 4-6 weeks after each TACE procedure to determine tumor response and need for further treatment. Survival was calculated with use of the Kaplan-Meier survival curve. RESULTS: The median survival for 17 patients treated with TACE was 23 months. Two patients with previously unresectable disease underwent successful resection after TACE. The procedure was well tolerated by 82% of the patients, who experienced no side effects or mild side effects that quickly resolved with conservative therapy alone. Two patients had minor complications (12%), which were managed successfully, and one had a major complication that resulted in a fatal outcome. This patient had a rapidly declining course from the time of diagnosis and died shortly after TACE. CONCLUSIONS: The results suggest that TACE was effective at prolonging survival of patients with unresectable cholangiocarcinoma. Therefore, for these patients, TACE may be an appropriate palliative therapy.     

Improved oncologic outcome with chemoradiotherapy followed by surgery in unresectable intrahepatic cholangiocarcinoma

Purpose

To investigate the ability of chemoradiotherapy (CRT) to down-stage unresectable intrahepatic cholangiocarcinoma (IHCC) to resectable lesions, as well as the factors associated with achieving such down-staging.

Methods

The study cohort comprised 120 patients diagnosed with stage I–IVA IHCC between 2001 and 2012. Of these patients, 56 underwent surgery and 64 received CRT as their initial treatment. The rate of curative resections for patients who received CRT was assessed, and the locoregional failure-free survival (LRFFS) and overall survival (OS) rates of these patients were compared to those of patients who underwent CRT alone.

Results

Median follow-up was 36 months. A partial response after CRT was observed in 25% of patients, whereas a biologic response (a >70% decrease of CA19-9) was observed in 35%. Eight patients (12.5%) received curative resection after CRT and showed significantly improved LRFFS and OS compared to those treated with CRT alone (3-year LRFFS: 50 vs. 15.7%, respectively, p = 0.03; 3?year OS: 50 vs. 11.2%, respectively, p = 0.012); these rates were comparable to those of patients who received initial surgery. Factors associated with curative surgery after CRT were gemcitabine administration, higher radiotherapy dose (biological effective dose ≥55?Gy with α/β = 10), and a >70% reduction of CA19-9.

Conclusion

Upfront CRT could produce favorable outcomes by converting unresectable lesions to resectable tumors in selected patients. Higher radiotherapy doses and gemcitabine-based chemotherapy yielded a significant reduction of CA19-9 after CRT; patients with these characteristics had a greater chance of curative resection and improved OS.

     

放射治疗在肝门部胆管癌综合治疗中的作用

肝门部胆管癌是少见的恶性肿瘤。根治性手术是肝门部胆管癌患者获得长期生存的惟一预后因素,但手术切除率很低,术后放射治疗可以提高姑息切除者的局部控制率和长期生存率。绝大多数肝门部胆管癌患者就诊时为不可切除的晚期肿瘤,并伴有不同程度的胆道梗阻症状,各种胆汁引流术可以有效地缓解胆道梗阻,但并不能延长生存期。回顾性临床分析结果表明,在胆汁引流基础上的放射治疗可以进一步缓解症状,延长生存期。放疗方式可以分为单纯外照射、外照射结合腔内放疗以及新的放射技术的应用。有效的肝门部胆管癌综合治疗手段还有待于前瞻性、随机对照的临床试验。     

肝门部胆管癌的外科治疗

目的：探讨肝门部胆管癌外科治疗策略及其治疗结果。方法：回顾性分析1997—09～2004-10收治的28例肝门部胆管癌的临床资料。结果：Bismuth—CorletteⅠ型10例，Ⅱ型8例，Ⅲa型4例，Ⅲb型3例，Ⅳ型3例。手术切除16例(57．1％)，其中根治性切除11例(39．3％)，姑息性切除5例(17．8％)，外引流7例(25．6％)，剖腹探查5例(17．9％)。手术切除组、外科引流组及剖腹探查组的平均生存时间分别为20．6、7．3及1．5个月。1例术后10d因肾功能衰竭死亡。结论：治疗应以手术切除为主，根治性切除术可延长患者生存时间。对不能切除的病例应设法减轻黄疸。     

Staging of Klatskin tumours (hilar cholangiocarcinomas): comparison of MR cholangiography, MR imaging, and endoscopic retrograde cholangiography

The aim of the study was to compare prospectively magnetic resonance cholangiography (MRC) and magnetic resonance imaging (MRI) with endoscopic retrograde cholangiography (ERC) in the diagnosis and staging of Klatskin tumours of the biliary tree (hilar cholangiocarcinomas). Forty-six patients with suspected Klatskin tumours of the biliary tract underwent MRI and heavily T2-weighted, non-breathhold, respiratory-triggered fast spin-echo MRC. Forty-two patients underwent ERC within 24 h; in four patients, ERC was not feasible, and percutaneous trans-hepatic cholangiography (PTC) was carried out instead. Two independent investigators evaluated imaging results for the presence of tumour, bile duct dilatation, and stenosis. Clinical and histopathological correlation revealed Klatskin tumours in 33 patients. MRI revealed a slightly hyperintense signal of infiltrated bile ducts in T2-weighted fast spin-echo sequences. The malignant lesion was regularly visualized as a hypointense area in T1-weighted gradient-echo sequences with substantial contrast enhancement along the involved bile duct walls. MRC revealed the location and extension of the tumour in 31 of 33 cases correctly (sensitivity 94%, specificity 100%, diagnostic accuracy 95%). In 27 of 31 cases, ERC enabled accurate staging and diagnosis of Klatskin tumours with a sensitivity of 87%. ERC and PTC combined yielded a sensitivity of 84% and a specificity of 97%. Tumours were grouped according to the Bismuth classification, with MRC allowing correct identification of type I tumour in seven patients, type II tumour in four patients, type III tumour in 12 patients, and type IV tumour in ten patients. MRC provided superior visualization of completely obstructed peripheral systems. MRC in combination with MRI is a reliable non-invasive diagnostic method for the pre-therapeutic staging of Klatskin tumours.     

CT detection of hydronephrosis in resected colorectal cancer: a predictor of recurrent disease

AIM: To investigate the causes and significance of hydronephrosis in follow-up of colorectal cancer. METHODS AND MATERIALS: Case notes and serial computed tomography (CT) examinations were reviewed of 75 patients (250 CT examinations) after resection for colorectal cancer in whom hydronephrosis developed on follow-up. RESULTS: The most common cause of hydronephrosis was a focal plaque-like mass centred on the peritoneum, demonstrated in 37 cases (49%). Patients with R1 (microscopic residual tumour) or R2 (macroscopic residual tumour) disease developed hydronephrosis at a median time of 13 months (90% CI: 9-18 months) compared with 22 months (90% CI: 17-26 months) for those having (R0) curative resection. Patients with pT4 invasion of peritoneum or adjacent organs developed hydronephrosis at a median of 14 months (90% CI: 6-16 months) compared with a median of 22 months in patients with pT3 tumours (90% CI: 11-27 months). Of 26 patients without an obvious cause of hydronephrosis on initial CT examination, follow-up CT demonstrated a definite mass lesion in 50%. Median survival after the onset of hydronephrosis was 6 months (range 1-34 months) with a 1-year mortality of 62%. CONCLUSIONS: Hydronephrosis is an important early indicator of colorectal cancer recurrence, even in the absence of a mass.     

Postoperative versus definitive chemoradiation in early-stage anal cancer

Background and purpose

The goal of the present study was to comparatively assess the results of definitive chemoradiation (CRT) with or without previous macroscopically complete resection in patients with early-stage node-negative (T1–2 N0) anal carcinoma.

Patients and methods

A total of 20?patients with T1–2 N0 anal carcinoma who received radiotherapy (RT) with or without chemotherapy following incidental R0/1 tumor resection (S/CRT group) were selected. These were matched to 20?comparable patients who underwent definitive chemoradiation without previous surgery (CRT group). Major objectives of this analysis were treatment outcomes in terms of locoregional tumor control (LRC), overall survival (OS), colostomy-free survival, and toxicity.

Results

Patients treated postoperatively received significantly lower RT doses (median 54.0?Gy vs. 59.7?Gy; p?Conclusion This matched-pair comparison of incidental R0/1 resection plus dose-reduced CRT with standard definitive CRT of early-stage anal cancer shows similar treatment results. Thus, dose-reduced RT with or without chemotherapy may be considered in R0/1 resected patients with T1–2 N0 anal carcinoma.     

Transarterial Hepatic Yttrium-90 Radioembolization in Patients with Unresectable Intrahepatic Cholangiocarcinoma: Factors Associated with Prolonged Survival

Introduction

In unresectable intrahepatic cholangiocarcinoma (ICC), systemic chemotherapy often is viewed as the only option, although efficacy is limited. Radioembolization (RE) using yttrium-90 (⁹⁰Y) microspheres is an accepted therapy for patients with hepatocellular-carcinoma or metastatic liver tumors. However, there are limited data on the value of RE in patients with ICC and few data on factors influencing prognosis. The purpose of our retrospective analysis was to establish which factors influenced time-to-progression (TTP) and overall survival (OS).

Methods

Patients with unresectable ICC were treated with ⁹⁰Y resin-microspheres and assessed at 3-monthly intervals. Radiologic response was evaluated by using Response Criteria in Solid Tumors (RECIST). Baseline characteristics, biochemical/clinical toxicities, and response were examined for impact on TTP and OS.

Results

Thirty-four treatments were administered to 33 patients without major complications. By RECIST, 12 patients had a partial response, 17 had stable disease, and 5 had progressive disease after 3?months. The median OS was 22?months posttreatment and 43.7?months postdiagnosis. Median TTP was 9.8?months. Survival and TTP were significantly prolonged in patients with ECOG 0 (vs. ECOG 1 or 2; median OS: 29.4, 10, and 5.1?months; TTP: 17.5, 6.9, and 2.4?months), tumor burden ??25% (OS: 26.7 vs. 6?months; TTP: 17.5 vs. 2.3?months), or tumor response (PR or SD vs. PD; OS: 35.5, 17.7 vs. 5.7?months; TTP: 31.9, 9.8 vs. 2.5?months), respectively (P?<?0.001).

Conclusions

Radioembolization is an effective and safe option for patients with unresectable ICC. Predictors for prolonged survival are performance status, tumor burden, and RECIST response.     

OEM-TACE: A New Therapeutic Approach in Unresectable Intrahepatic Cholangiocarcinoma

Intrahepatic cholangiocarcinoma (ICC) is a rare life-threatening disease, whose only treatment with potential for cure is surgical resection. However, only 27% of patients at most are suitable for surgery when first diagnosed. For patients with unresectable disease, therapeutic options are chemotherapy or chemoradiation. We evaluated the feasibilty and safety of oxaliplatin-eluting microspheres transarterial chemoembolization (OEM-TACE) associated with chemotherapy (ChT) in patients affected by unresectable ICC. Between December 2005 and May 2008 we treated nine patients (six female and three male) with unresectable ICC. All patients had undergone OEM-TACE associated with chemotherapy with oxaliplatin and gemcitabine. A retrospective comparison was carried out with a historical group of 11 patients treated with ChT only, estimating the prevalence of adverse effects and the median survival of the two groups. A total of 30 TACEs were performed during the observational time (ranging from one to seven procedures per patient). OEM-TACEs were followed by few adverse effects (AEs), without G4 AEs, according to CTACAE 3.0. According to RECIST criteria, 44% (4/9) of patients achieved partial responses and 56% (5/9) stabililization of disease. Overall survival analysis in the two groups showed a significantly increased survival in patients treated with ChT and OEM-TACE, with respect to those treated with ChT (30 vs. 12.7 months; p = 0.004). In conclusion, in our experience OEM-TACE associated with ChT in the treatment of advanced unresectable ICC is a safe and feasible treatment causing no major adverse events. Although RECIST criteria can underestimate the rate of responses in patients treated with locoregional therapies, we achieved very encouraging results. A randomized multicentric trial is warranted to assess the actual superiority of OEM-TACE associated with ChT compared to conventional chemotherapy.     

Chemoradiotherapy for patients with recurrent lymph-node metastasis or local recurrence of gastric cancer after curative gastrectomy

Objectives

Whether chemoradiotherapy (CRT) is clinically beneficial for the management of postoperative recurrence of advanced gastric cancer remains unclear. We retrospectively studied treatment outcomes in patients who had unresectable localized recurrence after surgery for advanced gastric cancer and evaluated the safety and efficacy of CRT.

Methods

The study group comprised 21 patients who received concurrent CRT for unresectable localized recurrence after undergoing R0 resection for stage II/III advanced gastric cancer. Localized recurrence was defined as a few or limited recurrent lesions.

Results

The recurrence pattern was anastomotic recurrence in 7 patients, abdominal lymph-node recurrence in 12, and anastomotic recurrence plus abdominal lymph-node recurrence in 2. The median total dose of radiotherapy was 48.6 Gy (range 39.6–56.0), and the CRT completion rate was 100 % (21 of 21 patients). CRT-related grade 3 or higher toxicity comprised neutropenia in 33.3 % of patients and anorexia in 9.5 %. The response rate was 61.9 % (complete response 38.1 %, partial response 23.8 %). The median overall survival was 35.0 months.

Conclusions

We conclude that CRT may become one treatment strategy for the management of unresectable localized recurrence after curative resection of advanced gastric cancer.

     

双介入治疗肝门部胆管癌的临床应用研究

目的：观察经皮肝胆管引流（PTCD）金属内支架植入术联合125I放射性粒子永久性植入术对肝门部胆管癌的临床治疗效果。方法：回顾性研究确诊为肝门部胆管癌的患者67例,分为两组：A组35例（PTCD金属内支架植入组）、B组32例（PTCD金属内支架植入＋125I放射性粒子植入组）,通过观察术后减黄效果、肿瘤大小变化、生存率及再梗阻时间,分析PTCD金属内支架植入术联合125I放射性粒子植入术治疗肝门部胆管癌的临床效果。结果：术后15天A、B两组总胆红素均下降且两组差异无显著性（P〉0.05）;术后3月A组总胆红素水平升高,B组未发现回升;术后6个月A、B两组总体有效率（CR＋PR）分别为15%（3/20）,72.4%（21/29）,A、B两组差异有显著性（P〈0.05）;术后6个月、12个月、36个月生存率,B组为90.6%（29/32）,74.3%（26/32）,40%（14/32）,明显高于A组的57.1%（20/35）,34.3%（12/35）,8.6%（3/35）（P〈0.05）。结论：PTCD金属内支架植入术为姑息性治疗;PTCD金属内支架植入术联合125I放射性粒子永久性植入术能达到较理想的治疗效果,并发症少,且提高患者的生存期,具有较高的临床价值。     

经皮肝穿刺胆管腔内射频消融联合植入支架治疗肝门胆管癌伴恶性梗阻临床疗效研究

目的探讨经皮肝穿刺胆管腔内射频消融联合植入支架治疗肝门胆管癌伴恶性梗阻患者的临床应用价值。方法选取自2013年1月至2014年6月收治的肝门胆管癌伴恶性梗阻患者36例,行经皮肝穿刺胆管腔内射频消融联合植入支架进行治疗,观察患者术后并发症发生与肝功能变化情况。所有患者每月随访1次至术后1年,记录患者的存活率与支架通畅率。结果所有患者均手术成功,成功率为100.0%(36/36)。术后发生出血1例(2.7%),胆道感染4例(11.1%),腹泻5例(13.9%),呕吐6例(16.7%),疼痛10例(27.8%),对症治疗后均好转。术后1周,患者总胆红素、直接胆红素、谷氨酰转肽酶与碱性磷酸酶均明显低于术前,差异有统计学意义(P<0.05)。术后3、6、12个月的支架通畅率分别为91.7%(33/36)、69.4%(25/36)、38.9%(14/36);存活率分别为97.2%(35/36)、80.6%(29/36)、66.7%(24/36)。结论经皮肝穿刺胆管腔内射频消融联合植入支架治疗肝门胆管癌伴恶性梗阻安全有效,值得临床推广应用。     

Staging of hilar cholangiocarcinoma by ultrasound and duplex sonography: a comparison with angiography and operative findings.

The pre-operative radiological assessment of proximal bile duct tumours is clinically important as resection may be limited by tumour extension along the bile ducts, into hepatic parenchyma or the adjacent vascular structures. Demonstration of the extent of biliary and vascular involvement can direct additional investigations and definitive treatment. 22 patients with hilar cholangiocarcinoma were studied pre-operatively by conventional ultrasound (US) and duplex sonography (DS). The extent of tumour infiltration and vascular involvement was compared with arteriography and operative findings. Bile duct dilatation and the level of obstruction was documented by US in 22 (100%), and the tumour was shown by US in 19 (86%). In these 19 patients, the extent of extraductal extension compared with operative findings was correct in 13, underestimated in two, and in four infiltration was massed. Vascular patency or involvement was correctly determined by DS in 19 (86%), and by arteriography in 18 (82%). In two of the three incorrect DS interpretations, lobar atrophy and contralateral hypertrophy distorted the hilar anatomy. US with DS is valuable in the pre-operative staging of proximal bile duct tumours in predicting ductal and vascular involvement.     

金属内支架和局部治疗相结合治疗肝门部胆管癌

目的：提高肝门部胆管癌疗效，延长生存时间、改善生存质量。材料与方法：２４例非手术肝门部胆管癌患者先行ＰＴＣＤ减黄术，其中１８例再行局部治疗（胆道内照射或局部化疗）并留置金属内支架１周后拔去引流管，另６例仅行ＰＴＣＤ治疗。结果：２４例行ＰＴＣＤ治疗后，２２例总胆红素下降，未见改变的２例在１个月内死亡。１８例行局部治疗并留置金属内支架的病例，平均生存１０个月，最长２４个月。平均无管（指拔去引流管）生存为５．５个月，最长为１７个月。另６例平均生存２个月，最长为６个月。结论：（１）行局部治疗并留置金属内支架病例的生存时间明显长于单纯ＰＴＣＤ治疗的病例。（２）ＰＴＣＤ后胆红素未见改变或上升者预后不佳。（３）ＰＴＣＤ后的胆道内留置金属内支架与局部治疗相结合是非手术治疗肝门部胆管癌的有效方法。     

Computed Tomography-Guided Interstitial HDR Brachytherapy (CT-HDRBT) of the Liver in Patients with Irresectable Intrahepatic Cholangiocarcinoma

Purpose

This study was designed to investigate the clinical outcome of patients with irresectable, intrahepatic cholangiocarcinoma (IHC) treated with computed tomography (CT)-guided HDR-brachytherapy (CT-HDRBT) for local tumor ablation.

Method

Fifteen consecutive patients with histologically proven cholangiocarcinoma were selected for this retrospective study. Patients were treated by high-dose-rate internal brachytherapy (HDRBT) using an Iridium-192 source in afterloading technique through CT-guided percutaneous placed catheters. A total of 27 brachytherapy treatments were performed in these patients between 2006 and 2009. Median tumor enclosing target dose was 20?Gy, and mean target volume of the radiated tumors was 131 (±?90) ml (range, 10?C257?ml). Follow-up consisted of clinical visits and magnetic resonance imaging of the liver every third month. Statistical evaluation included survival analysis using the Kaplan?CMeier method.

Results

After a median follow-up of 18 (range, 1?C27) months after local ablation, 6 of the 15 patients are still alive; 4 of them did not get further chemotherapy and are regarded as disease-free. The reached median local tumor control was 10?months; median local tumor control, including repetitive local ablation, was 11?months. Median survival after local ablation was 14?months and after primary diagnosis 21?months.

Conclusion

In view of current clinical data on the clinical outcome of cholangiocarcinoma, locally ablative treatment with CT-HDRBT represents a promising and safe technique for patients who are not eligible for tumor resection.