A retrospective comparison of endoscopic stenting alone with stenting and radiotherapy in non-resectable cholangiocarcinoma.

Abstract

Background and Aims-Radiotherapy has been reported to be of benefit in prolonging the survival of patients with cholangiocarcinoma. This study examined whether radiotherapy in addition to endoscopic stenting improved survival. Subjects-56 patients with obstructive jaundice due to histologically confirmed non-resectable cholangiocarcinoma. Methods-A retrospective analysis of these patients who were treated either with endoscopic biliary stenting followed by external beam radiotherapy and internal iridium-192 brachytherapy (n=28) or with stenting alone (control group; n=28). Results-The two groups were well matched in age, sex, and stricture type. Eighteen patients had a type I stricture (control group: 11; radiotherapy group: 7) at the time of diagnosis and 38 had a type II or III stricture (control group: 17; radiotherapy group: 21). The median (range) overall survival from diagnosis was seven (1-29) and 10 (4-75) months in the control and radiotherapy groups respectively: This difference did not reach statistical significance (p=0.06), but survival plots indicated a survival advantage in the radiotherapy group in the first nine months after diagnosis. Approximately one third survived longer than one year in both groups. More patients in the radiotherapy group required a stent change (1.9 v 0.9: p=005), and also had a longer overall inpatient stay (42 days v 19: p<0.001). When examined on the basis of stricture type, there was a survival advantage in the first 10 months after diagnosis in those with a type II/III stricture (seven and 11 months in the radiotherapy and control groups respectively: 0.Ol<p<0.05). There was no difference in survival between the groups in those with a type I stricture. Numbers surviving longer than one year, stent survival, and number of stent changes were all similar between the two groups when examined on the basis of stricture type, but length of hospital stay remained considerably longer in all patients receiving radiotherapy. Conclusion-The survival advantage of radiotherapy in those with a type II/III stricture is seen only in the first 10 months after diagnosis. The costs of radiotherapy and significantly increased time spent in hospital, however, raise doubts over its routine use in the management of nonresectable cholangiocarcinoma (Gut 1996; 39: 852-855)

Treatment options for other hepatic malignancies

“…One study found a median survival of 10 months (range, 4 to 75 months) with external-beam irradiation combined with internal irridium 192 brachytherapy in 28 patients compared with 7 months (range, 1 to 29 months) in a similar number of patients managed by endoscopic stenting. 5 In another study, median survival using the combination of external-beam irradiation, transcatheter irridium, and chemotherapy with fluorouracil was 13 months (range, 8 months to 9 years). 6 The apparent benefits of local irradiation have not been translated into survival benefits because of recurrent disease within the liver or abdominal cavity.…”

Diagnosis and initial management of cholangiocarcinoma with obstructive jaundice

“…EMSs are inserted percutaneously [61][62][63] or endoscopically [59,64] . Biliary stent placement combined with local tumor therapy, such as brachytherapy, extra-radiation therapy, or arterial infusion chemotherapy, can prolong the survival time of patients with malignant biliary obstruction [65][66][67][68] . Mezawa et al [69] developed a new PTBD tube coated with carboplatin.…”

Photodynamic therapy for advanced bile duct cancer: Evidence for improved palliation and extended survival

“…2,5 Survival with nonresectable tumor lasts for a median of 3 months without intervention and 4 to 6 months with biliary drainage. [11][12][13][14][15] Given the longer hospitalization time, the adverse effects, and the marginal life extension with anticancer therapies, 2,[16][17][18] usual palliation still is biliary drainage only.…”