Saito Hiroya, Takada Tadahiro, Miyazaki Masaru, Miyakawa Shuichi, Tsukada Kazuhiro, Nagino Masato, Kondo Satoshi, Furuse Junji, Tsuyuguchi Toshio, Kimura Fumio, Yoshitomi Hideyuki, Nozawa Satoshi, Yoshida Masahiro, Wada Keita, Amano Hodaka, Miura Fumihiko
Department of Radiology, Asahikawa Kosei General Hospital, Asahikawa 078-8211, Japan.
J Hepatobiliary Pancreat Surg. 2008;15(1):63-8. doi: 10.1007/s00534-007-1281-y. Epub 2008 Feb 16.
The purpose of radiation therapy for unresectable biliary tract cancer is to prolong survival or prolong stent patency, and to provide palliation of pain. For unresectable bile duct cancer, there are a number of studies showing that radiation therapy is superior to the best supportive care. Although radiation therapy is used in many institutions, no large randomized controlled trials (RCTs) have been performed to date and the evidence level supporting the superiority of this treatment is low. Because long-term relief of jaundice is difficult without using biliary stenting, a combination of radiation therapy and stent placement is commonly used. As radiation therapy, external-beam radiation therapy is usually performed, but combined use of intraluminal brachytherapy with external beam radiation therapy is more useful for making the treatment more effective. There are many reports demonstrating improved response rates as well as extended survival and time to recurrence achieved by this combination therapy. Despite the low level of the evidence, this combination therapy is performed at many institutions. It is expected that multi-institutional RCTs will be carried out. Unresectable gallbladder cancer with a large focus is usually extensive, and normal organs with high radio sensitivity exist contiguously with it. Therefore, only limited anticancer effects are to be expected from external beam radiation therapy for this type of cancer. The number of reports on ampullary cancer is small and the role of radiation therapy in this cancer has not been established. Combination treatment for ampullary cancer consists of either a single use of intraoperative radiation therapy, postoperative external beam radiation therapy or intraluminal brachytherapy, or a combination of two or three of these therapies. Intraoperative radiation therapy is superior in that it enables precise irradiation to the target site, thereby protecting adjacent highly radiosensitive normal tissues from irradiation. There are reports showing extended survival, although not significant, in groups undergoing intraoperative or postoperative radiation therapy compared with groups without radiation therapy. To date, there are no reports of large RCTs focusing on the significance of radiation therapy as a postoperative adjuvant treatment, so its usefulness as a postoperative adjuvant treatment is not proven. An alternative treatment is photodynamic therapy. There is an RCT demonstrating that, in unresectable bile duct cancer, extended survival and improved quality of life (QOL) have been achieved through a combination of photodynamic therapy and biliary stenting, compared with biliary stenting alone. Results from large RCTs are desired.
不可切除胆管癌的放射治疗目的是延长生存期或延长支架通畅时间，并缓解疼痛。对于不可切除的胆管癌，多项研究表明放射治疗优于最佳支持治疗。尽管许多机构都在使用放射治疗，但迄今为止尚未进行大规模随机对照试验（RCT），支持这种治疗优越性的证据级别较低。由于不使用胆管支架很难实现黄疸的长期缓解，因此放射治疗与支架置入联合使用较为常见。作为放射治疗，通常采用外照射放疗，但腔内近距离放疗与外照射放疗联合使用对提高治疗效果更有用。有许多报告表明，这种联合治疗可提高缓解率，并延长生存期和复发时间。尽管证据级别较低，但许多机构仍在进行这种联合治疗。预计将开展多机构RCT。具有大病灶的不可切除胆囊癌通常范围广泛，且与之相邻的是对放射敏感性高的正常器官。因此，对于这类癌症，外照射放疗预期只能产生有限的抗癌效果。关于壶腹癌的报告数量较少，放射治疗在这种癌症中的作用尚未确定。壶腹癌的联合治疗包括单独使用术中放射治疗、术后外照射放疗或腔内近距离放疗，或这三种治疗中的两种或三种联合使用。术中放射治疗的优势在于能够对靶部位进行精确照射，从而保护相邻的高放射敏感性正常组织免受照射。有报告显示，与未接受放射治疗的组相比，接受术中或术后放射治疗的组生存期有所延长，尽管差异不显著。迄今为止，尚无聚焦放射治疗作为术后辅助治疗意义的大型RCT报告，因此其作为术后辅助治疗的有效性尚未得到证实。另一种治疗方法是光动力疗法。一项RCT表明，在不可切除胆管癌中，与单纯胆管支架置入相比，光动力疗法与胆管支架置入联合使用可延长生存期并改善生活质量（QOL）。期待大型RCT的结果。
