Relief of jaundice by external beam radiotherapy and intraluminal brachytherapy in patients with extrahepatic cholangiocarcinoma: results without stenting.

BACKGROUND/AIMS: To clarify whether external beam radiotherapy combined with intraluminal brachytherapy without stenting provides long-term relief of jaundice in extrahepatic cholangiocarcinoma patients.
METHODOLOGY: Twenty-five patients with unresectable hilar or distal cholangiocarcinoma were treated by external beam radiotherapy (30 or 50 Gy) combined with intraluminal brachytherapy (24 to 40 Gy). After radiotherapy, we removed the biliary drainage tubes from the patients who responded, and we did not perform stenting in these patients.
RESULTS: In 19 (76%) patients, full patency was achieved at the treated lesion, and they were tube-free thereafter. The tube-free survival time in the 19 patients ranged from 7 to 468 days (median: 76 days). Cholangitis and gastroduodenal ulcer developed in 10 (40%) and 2 (8%) patients, respectively, as adverse events after the combined radiotherapy. The median survival time of all patients was 9.3 months, and their 6- and 12-month survival rates were 75.3% and 29.3%, respectively. The ratios of tube-free to overall survival in the 19 patients ranged from 2.4% to 79.4% (median: 26.8%). Eight patients died tube-free.
CONCLUSIONS: Although there were limitations to the long-term relief of jaundice by this combined radiotherapy alone, tube-free status was achieved in some patients without stenting.