BACKGROUND/AIMS: The aim of our study was to evaluate preliminary results of intensity modulated radiotherapy (IMRT) in patients with inoperable subhepatic tumors. METHODOLOGY: Thirteen patients with inoperable cholangiocarcinoma or gall bladder carcinoma were treated by biliary drainage and intensity modulated radiotherapy. In patients with tumors limited to the biliary duct only tumor stenosis was irradiated to the dose of 50-60 Gy. In patients with bulky extraductal tumors the dose was 50 Gy/25 fractions to the whole tumor and an integrated boost was used to raise the dose to the malignant stenosis to 60 Gy/25 fractions. RESULTS: Doses to organs at risk (duodenum, small intestine, liver) were in tolerable limits. In four patients transient fever occurred; one patient had duodenal bleeding that resolved after conservative treatment. Recurrent dilatation of the biliary tract was observed in 4 patients and was managed by exchange of the internal biliary drainage. Median survival was 10.4 months, 5 patients survived for more than one year following diagnosis. CONCLUSIONS: IMRT of inoperable extrahepatic biliary tract tumors allows application of high doses of radiation to the tumor with effective sparing of healthy tissues. The control of jaundice is good. In selected cases IMRT may prolong overall survival.
- MeSH
- celková dávka radioterapie MeSH
- cholangiokarcinom radioterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory žlučníku radioterapie MeSH
- nádory žlučových cest radioterapie MeSH
- radioterapie s modulovanou intenzitou metody MeSH
- senioři MeSH
- žlučové cesty intrahepatální MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
PURPOSE: To evaluate the effect of radiation therapy including intraluminal brachytherapy with iridium-192 on survival of patients with malignant biliary strictures (cholangiocarcinoma, histologically improved) treated with metallic stent in a prospective randomised study. METHOD AND MATERIALS: In the prospective randomised study, 21 patients with cholangiocarcinoma were treated with implantation of percutaneous stents followed with intraluminal Ir-192 brachytherapy (mean dose 30 Gy) and external radiotherapy (mean dose 50 Gy) and 21 patients were treated only with stents insertion. We did not find any statistically significant differences in age and tumor localization between these two groups of patients. RESULTS: All the patients died. In the group of patients treated with brachytherapy and with stent implantation, the mean survival time was 387.9 days. In the group of patients treated only with stent insertion the mean survival was 298 days. In effort to eliminate possible effect of external radiotherapy we treated the control group of eight patients with cholangiocarcinoma by stent insertion and brachytherapy only. CONCLUSION: Our results show that combined radiation therapy could extend the survival in the patients with cholangiocarcinoma obstruction.
- MeSH
- brachyterapie metody MeSH
- celková dávka radioterapie MeSH
- chirurgie žlučových cest přístrojové vybavení MeSH
- cholangiokarcinom chirurgie radioterapie MeSH
- dospělí MeSH
- Kaplanův-Meierův odhad MeSH
- kombinovaná terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory žlučových cest chirurgie radioterapie MeSH
- následné studie MeSH
- prospektivní studie MeSH
- radioizotopy iridia terapeutické užití MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stenty MeSH
- výsledek terapie MeSH
- žlučové cesty intrahepatální chirurgie patologie účinky záření MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- randomizované kontrolované studie MeSH
AIMS AND BACKGROUND: Conventional radiotherapy in inoperable cholangiocarcinoma is limited by radiotolerance of the surrounding tissues. The aim of our dosimetric study was an evaluation of intensity-modulated radiotherapy in the treatment of inoperable bile duct carcinoma. METHODS: Four patients with inoperable cholangiocarcinoma treated by self-expandable stent placed to the biliary tree and radiotherapy were studied. The rotational technique, conformal 3D BOX technique and intensity-modulated radiotherapy plan were compared. Dose volume histograms and the normal tissue complication probability concept were used for comparison. The stent was used for target motion verification. RESULTS: The intensity-modulated radiotherapy plans showed favorable dose distribution in planning target volume and remarkable sparing of organs at risk. CONCLUSIONS: The intensity-modulated radiotherapy technique in bile duct carcinomas deserves further research and clinical evaluation.
- MeSH
- celková dávka radioterapie MeSH
- cholangiokarcinom radioterapie terapie MeSH
- financování organizované MeSH
- kombinovaná terapie MeSH
- lidé MeSH
- nádory žlučových cest radioterapie terapie MeSH
- paliativní péče MeSH
- počítačová simulace MeSH
- radioterapie s modulovanou intenzitou metody MeSH
- stenty MeSH
- žlučové cesty extrahepatické MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
- MeSH
- adenokarcinom chirurgie radioterapie MeSH
- brachyterapie metody MeSH
- cholangiokarcinom radioterapie MeSH
- cholestáza radioterapie MeSH
- dospělí MeSH
- ductus choledochus radioterapie MeSH
- lidé MeSH
- nádory žlučníku radioterapie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
Cíl: Zhodnoceni efektu brachyterapie (Iridium - 192) v kombinaci se zavedením kovového stentu V prospektivní randomizované studii. Materiál a metodika: Celkem bylo ošetřeno 76 nemocných. Etiologie stenózy byla u všech ověřena histologický. 38 pacientů s inoperabilní maligní stenózou žlučových cest (skupina A) bylo léčeno perkutánní implantací stentu (Wallstent, spirální Z stent) a následnou brachyterapií (Ir-192, průměrná dávka 30 Gy). 38 nemocných (skupina B) mělo zavedeno jen Wallstent bez následného ozařování. Výsledky: Průměrná délka života nemocných (skupina A) byla 291,2, resp. (skupina B) 195,1 dnů. Ze statistického hodnocení jsme vyřadili pacienty, kteří zemřeli do jednoho měsíce. Závěr: Kombinace perkutánního zavedení stentu a následné rádioterapie statisticky významně prodlužuje délku života u nemocných s maligní stenózou žlučových cest léčenou zavedením kovového stentu. Nejvýraznější rozdíl jsme zaznamenali u nemocných s cholangiokarcinomem (339,8 A versus 298 B).
Objective: Evaluation of the effect of brachytherapy (Iridium-192) combined with insertion of a metal stent in a prospective randomized study. Material and methods: A total of 76 patients were treated. The etiology of stenosis was in all confirmed by histological examination. 38 patients with an inoperable malignant stenosis of the biliary pathways (group A) was treated by percutaneous implantation of a stent (Wallstent, spiral Z stent) and subsequent brachytherapy (Ir-192, mean dose 30 Gy). 38 patients (group B) had a Wallstent only without subsequent irradiation. Results: The mean survival time of patients (group A) was 291.2 days and 195.1 days (group B). From the statistical evaluation patients who died within one month were eliminated. Conclusion: A combination of percutaneous insertion of a stent and subsequent radiotherapy prolongs significantly the life span of patients with malignant stenosis of the biliary pathways treated by insertion of a metal stent. The most marked difference was recorded in patients with cholangiocarcinoma (339.8 A vs. 298 B).
