Intraluminal brachytherapy of the biliary tract

Review article: Biliary tree malignancies

“…Radiation-induced stricture formation is of concern particularly when intraluminal techniques are used, and the question of whether, after radiation, a malignant stricture is not simply replaced by a fibrotic stricture is important since all such strictures may be lifethreatening. Nag [32] speculates that intraluminal brachytherapy may lead to ductal fibrosis and strictures and recommends leaving the catheters in place several months after intraluminal therapy to avoid this. If the patient is anxious to have external drainage catheters removed, it is possible to convert from external to internal drainage.…”

“…Intraluminal brachytherapy (radiation delivered through the lumens of the bile ducts) may provide this option, providing access and additional dose delivery to the tumor while sparing the surrounding normal tissues [3,7,8,. EBRT usually precedes brachytherapy [8,15,16,19,20,[22][23][24]29,30,32,34,36,[39][40][41]43] to decrease tumor bulk before implantation so that residual disease is encompassed by the limited range of the intraluminal radiation. At some institutions, implantation has preceded EBRT [3,[10][11][12][13][14][16][17][18][19]33,[37][38].…”

“…A third treatment option for stented patients is intraluminal irradiation alone. Because this approach has certain limitations (i.e., bulky tumor will not be encom-passed by the limited penetration of the intraluminal sources), brachytherapy alone is reserved for palliation [3,7,8,[10][11][12][13][14][16][17][18][19][20][21][25][26][27][28][30][31][32]34,37,38,[42][43][44]50].…”

“…Transhepatic percutaneous catheter insertion (ring, pigtail) entails guiding a catheter into the dilated intrahepatic bile ducts, through the obstructing tumor, and into the duodenum, over a guidewire positioned during percutaneous cholangiography. This procedure provides both internal biliary drainage across the tumor and external drainage via the proximal end of the catheter [32,48,51].…”