Takamura Akio, Saito Hiroya, Kamada Tadashi, Hiramatsu Kazuhide, Takeuchi Shuhei, Hasegawa Masakazu, Miyamoto Noriyuki
Department of Radiology, Asahikawa Kosei Hospital, Asahikawa, Hokkaido, Japan.
Int J Radiat Oncol Biol Phys. 2003 Dec 1;57(5):1357-65. doi: 10.1016/s0360-3016(03)00770-3.
To evaluate the results of combined-modality therapy, including external beam radiotherapy, intraluminal (192)Ir, and biliary stenting for extrahepatic bile duct carcinoma.
Between 1988 and 1998, 93 patients with unresectable extrahepatic bile duct carcinoma underwent definitive radiotherapy. The dose of external beam radiotherapy was 50 Gy in 25 fractions. Low-dose-rate (192)Ir was delivered at a dose of 27-50 Gy (mean 39.2) at 0.5 cm from the source. An expandable metallic endoprosthesis was used to establish an internal bile passage.
The median survival was 12 months, with a 1-, 3-, and 5-year actuarial survival rate of 50%, 10%, and 4%, respectively. Tumor length, hepatic invasion, and distant metastasis significantly affected survival. Ninety-six percent of patients could successfully remove external drainage catheters. The actuarial biliary patency rate for these patients at 1, 3, and 5 years was 52%, 29%, and 18%, respectively. Tumor length, tumor diameter and T stage were significantly associated with the patency rate. Mild-to-severe gastroduodenal complications were observed in 32 patients and were significantly associated with the active length of (192)Ir and linear source activity. Eight patients had treatment-related biliary fistula.
Our combined-modality therapy provided reasonable local control and improved the quality of life of patients with extrahepatic bile duct carcinoma. Because none of the treatment characteristics had any impact on survival or biliary patency, lower dose levels and/or a localized target volume are recommended to minimize morbidity.
评估综合治疗的结果，包括外照射放疗、腔内（192）铱放疗和胆管支架置入术治疗肝外胆管癌的效果。
1988年至1998年间，93例无法切除的肝外胆管癌患者接受了根治性放疗。外照射放疗剂量为50 Gy，分25次给予。低剂量率（192）铱在距源0.5 cm处给予27 - 50 Gy（平均39.2 Gy）的剂量。使用可扩张金属内支架建立胆汁内引流通道。
中位生存期为12个月，1年、三年和5年的精算生存率分别为50%、10%和4%。肿瘤长度、肝侵犯和远处转移显著影响生存期。96%的患者能够成功拔除体外引流导管。这些患者1年、3年和5年的精算胆管通畅率分别为52%、29%和18%。肿瘤长度、肿瘤直径和T分期与通畅率显著相关。32例患者观察到轻至重度胃十二指肠并发症，且与（192）铱的施源长度和线性源活度显著相关。8例患者出现与治疗相关的胆瘘。
我们的综合治疗提供了合理的局部控制，提高了肝外胆管癌患者的生活质量。由于没有任何治疗特征对生存期或胆管通畅率有影响，因此建议采用较低剂量水平和/或缩小靶体积，以尽量减少并发症。
