Intraluminal endocurietherapy of inoperable Klatskin's tumor with high-activity 192iridium.

Five patients with Klatskin's tumor (adenocarcinoma of the hepatic duct bifurcation) were treated with high-activity 192Iridium endocurietherapy [ECT]. Two ribbons containing ten and five seeds of 192Iridium, respectively, were threaded into right and left percutaneous biliary drainage catheters. This "Y-shaped" distribution of iridium seeds irradiates a target volume which corresponds very well to the "Y-shaped" volume of a Klatskin's tumor. With our technique, significantly larger volumes (average 9 X 7 X 5 cm) can be treated to the endocurietherapy target dose of 60.00 Gy in 120 hours. For potentially curable cases, an additional 40.00 Gy in five weeks is delivered to the tumor bed by conventional external-beam radiotherapy (100.00 Gy total dose). For palliative cases, ECT alone is used. This endocurietherapy is an improvement over the current technique using standard strength seeds, which delivers 50.00 Gy to a tumor volume approximately one centimeter in diameter in 100-120 hours.