Inoue Masayoshi, Shimoda Emiko, Rikihisa Shota, Isohashi Fumiaki
Department of Radiology, Higashiosaka City Medical Center, Higashiosaka, JPN.
Department of Radiation Oncology, Nara Medical University, Kashihara, JPN.
Cureus. 2025 Mar 20;17(3):e80916. doi: 10.7759/cureus.80916. eCollection 2025 Mar.
Intraductal papillary neoplasms of the bile duct (IPNBs) have a high propensity for malignant transformation; therefore, surgical resection remains the standard first-line treatment. In cases where hepatic lobectomy is not feasible, however, controlling biliary drainage can be challenging. We present herein a case of unresectable IPNB complicated by jaundice and cholangitis due to mucin production by the tumor. Stereotactic body radiation therapy (SBRT) has been used as a treatment modality, resulting in favorable outcomes. An 80-year-old male patient presented to the emergency room with symptoms of cholangitis, for which he had previously undergone endoscopic lithotripsy for the removal of choledochal stones. The persistent symptoms and viscous bile led to suspicions of IPNB; therefore, the patient underwent a peroral cholangioscopy with biopsy to confirm the diagnosis. Due to his compromised cardiac function, however, surgical resection was not deemed a viable option, and biliary drainage was attempted instead. Unfortunately, frequent mucin-induced obstructions of the catheter made it difficult to control the cholangitis; therefore, SBRT was administered to achieve local tumor control and reduce mucin production. The radiation was delivered using a 10 MV beam with a volumetric-modulated arc therapy, fiducial gold markers, and suspended exhalation. A total dose of 60 Gy was administered across eight fractions (planning target volume D95), and one month post-SBRT, the biliary dilation and cholangitis had resolved. No local tumor regrowth or recurrent cholangitis occurred for at least one year after treatment, nor were any significant adverse effects related to the SBRT observed. According to the Surveillance, Epidemiology, and End Results (SEER) database, SBRT has been performed for IPNB; however, only a few case reports have been identified, all of which were cases in which brachytherapy was performed. To our knowledge, this is the first case report detailing a treatment regimen of SBRT with a definite radiation dose. This case suggests that SBRT may be of value as an alternative therapy for cases in which surgical resection is not an option.
胆管内乳头状肿瘤（IPNBs）具有较高的恶变倾向；因此，手术切除仍是标准的一线治疗方法。然而，在无法进行肝叶切除的情况下，控制胆管引流可能具有挑战性。我们在此介绍一例不可切除的IPNB病例，该病例因肿瘤产生黏液而并发黄疸和胆管炎。立体定向体部放射治疗（SBRT）已被用作一种治疗方式，并取得了良好的效果。一名80岁男性患者因胆管炎症状就诊于急诊室，他此前曾接受内镜碎石术以清除胆总管结石。持续的症状和黏稠的胆汁引发了对IPNB的怀疑；因此，患者接受了经口胆管镜检查及活检以确诊。然而，由于其心功能受损，手术切除被认为不可行，转而尝试胆管引流。不幸的是，黏液频繁导致导管阻塞，难以控制胆管炎；因此，给予SBRT以实现局部肿瘤控制并减少黏液产生。使用10 MV射束、容积调强弧形治疗、基准金标记和屏气进行放疗。共给予8个分割剂量，总剂量60 Gy（计划靶体积D95），SBRT治疗后1个月，胆管扩张和胆管炎已消退。治疗后至少1年未发生局部肿瘤复发或复发性胆管炎，也未观察到与SBRT相关的任何严重不良反应。根据监测、流行病学和最终结果（SEER）数据库，已对IPNB进行了SBRT治疗；然而，仅发现少数病例报告，所有这些病例均为进行近距离放疗的病例。据我们所知，这是第一例详细描述具有明确放疗剂量的SBRT治疗方案的病例报告。该病例表明，对于无法进行手术切除的病例，SBRT可能作为一种替代治疗方法具有价值。
