Lo S S, Wu C W, Chi K H, Tseng H S, Shen K H, Hsieh M C, Lui W Y
Division of General Surgery, Department of Surgery, Veterans General Hospital-Taipei and National Yang Ming University, Taipei, Taiwan.
Cancer. 2000 Jul 1;89(1):29-34.
The aim of this study was to determine the role of concomitant chemoradiation in the alleviation of obstructive jaundice in patients with extrahepatic biliary tract metastases from gastric carcinoma.
Thirteen patients with good performance status who had obstructive jaundice resulting from extrahepatic biliary metastases after gastrectomy for gastric carcinoma were treated with palliative intent. Treatment consisted of insertion of a percutaneous transhepatic choledochal drainage (PTCD) catheter followed by external radiation up to a total dose of 40-60 grays in combination with chemotherapy (cisplatin 20 mg/m(2)/day, 5-fluorouracil 600 mg/m(2)/day, and leucovorin 90 mg/m(2)/day for 96 hours during the first and fifth weeks) on an outpatient basis.
The concomitant chemoradiation produced a good palliative effect in all 13 patients. Hyperbilirubinemia continued to improve after treatment, patients' clay-colored stool resolved within an average of 4 weeks (range, 2-6 weeks), and bilirubin levels returned to normal. The PTCD catheter could be removed after treatment was completed (the seventh week); the mean duration of PTCD placement was 2 months. The entire treatment course was performed on an outpatient basis; hospital admission was necessary only for PTCD insertion and chemotherapy. Ten patients died of their disease, with an average survival of 14.4 months (range, 4-31 months) from the time of PTCD insertion. Three patients are still alive at 16, 21, and 8 months. Biliary tract patency was maintained until death. No serious treatment-related complications occurred, and no endoprothesis or intraluminal brachytherapy was needed in this study.
Satisfactory palliation can be achieved by concomitant chemoradiation for patients with obstructive jaundice resulting from extrahepatic biliary metastases from gastric carcinoma, providing an alternative treatment choice for these patients.
本研究旨在确定同步放化疗在缓解胃癌肝外胆管转移患者梗阻性黄疸中的作用。
13例胃癌胃切除术后因肝外胆管转移导致梗阻性黄疸且身体状况良好的患者接受了姑息性治疗。治疗包括经皮经肝胆道引流（PTCD）导管置入，随后进行外照射，总剂量达40 - 60格雷，并联合化疗（顺铂20mg/m²/天、5-氟尿嘧啶600mg/m²/天、亚叶酸钙90mg/m²/天，在第1周和第5周持续96小时），在门诊进行。
同步放化疗在所有13例患者中均产生了良好的姑息效果。治疗后高胆红素血症持续改善，患者的白陶土样便平均在4周内（范围2 - 6周）消失，胆红素水平恢复正常。治疗完成后（第7周）可拔除PTCD导管；PTCD放置的平均持续时间为2个月。整个治疗过程在门诊进行；仅PTCD置入和化疗时需要住院。10例患者死于疾病，从PTCD置入时起平均生存14.4个月（范围4 - 31个月）。3例患者分别在16、21和8个月时仍存活。直到死亡时胆管通畅得以维持。本研究中未发生严重的治疗相关并发症，也无需内支架或腔内近距离放疗。
对于胃癌肝外胆管转移导致梗阻性黄疸的患者，同步放化疗可实现满意的姑息治疗效果，为这些患者提供了一种替代治疗选择。
