Montemaggi P, Morganti A G, Dobelbower R R, Brizi G, Smaniotto D, Costamagna G, Cellini N, Marano P
Department of Radiation Oncology, Universita' Cattolica del Sacro Cuore, Rome, Italy.
Radiology. 1996 Jun;199(3):861-6. doi: 10.1148/radiology.199.3.8638018.
To evaluate intraluminal brachytherapy (ILBT) in patients with extrahepatic bile duct or pancreatic cancers.
Thirty-one patients (aged 33-87 years) with unresectable extrahepatic bile duct (n = 18) or pancreatic (n = 13) cancer received ILBT exclusively or as part of a definitive treatment regimen. ILBT was performed with transhepatic percutaneous drainage in four patients and with endoscopic retrograde cholangiopancreatography in 27. Fourteen patients with no metastases, an Eastern Cooperative Oncology Group performance score of < or = 2, and good hematologic parameters received combined modality treatment: 30-Gy ILBT and 45-Gy external-beam radiation therapy with continuous infusion of fluorouracil. Seventeen patients underwent 50-Gy ILBT alone for palliation.
No direct treatment-related acute toxic reactions were seen. Three patients had cholangitis early in the study. Three patients had late gastrointestinal bleeding. Jaundice was palliated in all patients (n = 29); pain, in 11 of 13 patients. The survival rate in patients with extrahepatic bile duct cancer was 62% (five of eight) at 2 years for combined modality treatment. No patient with pancreatic cancer lived for longer than 2 years.
ILBT is an effective palliative treatment of unresectable extrahepatic bile duct and pancreatic cancers. Results suggest a possible "curative" role in specific clinical settings when properly integrated with other treatments.
评估肝外胆管癌或胰腺癌患者的腔内近距离放射治疗（ILBT）。
31例（年龄33 - 87岁）无法切除的肝外胆管癌（n = 18）或胰腺癌（n = 13）患者单独接受ILBT或作为确定性治疗方案的一部分接受该治疗。4例患者通过经肝穿刺引流进行ILBT，27例通过内镜逆行胰胆管造影进行。14例无转移、东部肿瘤协作组体能状态评分为≤2且血液学指标良好的患者接受联合治疗：30 Gy的ILBT和45 Gy的外照射放疗并持续输注氟尿嘧啶。17例患者单独接受50 Gy的ILBT以缓解症状。
未观察到直接与治疗相关的急性毒性反应。3例患者在研究早期发生胆管炎。3例患者出现晚期胃肠道出血。所有患者（n = 29）黄疸均得到缓解；13例患者中有11例疼痛缓解。联合治疗的肝外胆管癌患者2年生存率为62%（8例中的5例）。没有胰腺癌患者存活超过2年。
ILBT是无法切除的肝外胆管癌和胰腺癌的一种有效姑息治疗方法。结果表明，在与其他治疗方法适当联合时，在特定临床情况下可能具有“治愈”作用。
