Shin Hyun Soo, Seong Jinsil, Kim Woo Chul, Lee Hyung Sik, Moon Sun Rock, Lee Ik Jae, Lee Kang Kyu, Park Kyung Ran, Suh Chang Ok, Kim Gwi Eon
Department of Radiation Oncology, Pundang CHA General Hospital, Sungnam, South Korea.
Int J Radiat Oncol Biol Phys. 2003 Sep 1;57(1):105-12. doi: 10.1016/s0360-3016(03)00410-3.
To assess the feasibility and therapeutic benefits of a combination of external beam radiotherapy (EBRT) and high-dose-rate intraluminal brachytherapy (ILBT) for treating patients with inoperable carcinoma of the extrahepatic bile ducts.
Of 31 patients who received RT at the Yonsei Cancer Center, Yonsei University College of Medicine in Seoul, Korea between 1986 and 1995, 17 patients underwent EBRT alone (Group 1) and 14 patients were treated with EBRT in combination with high-dose-rate ILBT (Group 2). After external drainage, EBRT was delivered with a total dose ranging from 36 to 55 Gy (median 50.4) in both groups. High-dose-rate ILBT for the patients in Group 2 was performed using a high-intensity (192)Ir source (Gamma-med remote afterloading system) within the expandable intrabiliary prosthesis (Gianturco stent), inserted transhepatically at the site of the obstruction. The radiation dose of the high-dose-rate ILBT was prescribed at 1.5 cm from the center of the source with a single daily dose of 5 Gy to a total of 15 Gy given in three fractions. The response rate, patterns of treatment failure, treatment morbidity, and survival data in the two groups were compared.
Although locoregional recurrence was the most common pattern of failure in both groups, no statistically significant difference was found in the recurrence rates between those who did and did not receive ILBT (53% for Group 1 vs. 36% for Group 2; p > 0.05). However, a prolongation of the median time to tumor recurrence was observed in the Group 2 patients (5 months for Group 1 vs. 9 months for Group 2; p = 0.06). When the EBRT dose delivered was >50 Gy, most patients experienced various degrees of GI symptoms, but the frequency of radiation-induced complications in the two groups was similar. No enhancement in treatment morbidity was attributed to the addition of high-dose-rate ILBT to EBRT. With a median follow-up of 12 months, the overall actuarial 2-year survival rate for Group 2 patients was significantly better than that for Group 1 patients (0% for Group 1 vs. 21% for Group 2; p = 0.015).
Given these observations, we believe that the combined use of EBRT and high-dose-rate ILBT is a beneficial, relatively safe, and effective method of improving the treatment outcome in selected patients with inoperable carcinoma of the extrahepatic bile ducts.
评估外照射放疗（EBRT）与高剂量率腔内近距离放疗（ILBT）联合应用于治疗无法手术切除的肝外胆管癌患者的可行性及治疗效果。
1986年至1995年间，在韩国首尔延世大学医学院延世癌症中心接受放疗的31例患者中，17例患者仅接受了EBRT（第1组），14例患者接受了EBRT联合高剂量率ILBT治疗（第2组）。两组患者在进行外引流后，EBRT的总剂量范围为36至55 Gy（中位剂量50.4 Gy）。第2组患者的高剂量率ILBT是通过高强度（192）Ir源（伽马后装治疗系统）在经肝插入梗阻部位的可扩张胆管内支架（Gianturco支架）内进行的。高剂量率ILBT的放射剂量在距源中心1.5 cm处规定，单次每日剂量为5 Gy，分三次共给予15 Gy。比较两组的缓解率、治疗失败模式、治疗并发症及生存数据。
虽然局部区域复发是两组最常见的失败模式，但接受和未接受ILBT的患者复发率在统计学上无显著差异（第1组为53%，第2组为36%；p>0.05）。然而，第2组患者的肿瘤复发中位时间有所延长（第1组为5个月，第2组为9个月；p = 0.06）。当给予的EBRT剂量>50 Gy时，大多数患者出现了不同程度的胃肠道症状，但两组放射诱导并发症的发生率相似。未发现高剂量率ILBT与EBRT联合应用会增加治疗并发症。中位随访12个月时，第2组患者的总体2年精算生存率显著优于第1组患者（第1组为0%，第2组为21%；p = 0.015）。
基于这些观察结果，我们认为EBRT与高剂量率ILBT联合应用是一种有益、相对安全且有效的方法，可改善部分无法手术切除的肝外胆管癌患者的治疗效果。
