TRATTAMENTO PERCUTANEO DEL COLANGIOCARCINOMA ILARE COMPLETATO CON BRACHITERAPIA CON ALTO RATEO DI DOSE. ESPERIENZA NEI PRIMI 5 CASI

Translated title of the contribution: Percutaneous treatment of hilar cholangiocarcinoma completed by intraluminal high dose rate (HDR) brachytherapy. Experience in the first 5 cases

D. Righi, J. Maass, E. Zanon, S. Tettoni, R. Orecchia, R. Lazzari, R. Ragona, G. Gandini

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Cholangiocarcinoma at the confluence of the hepatic ducts (Klatskin tumor) is a slowly growing malignancy with early onset of symptoms and poor outcome since surgery allows radical resection in only a minority of cases. Percutaneously placed biliary stents offer a good palliation, but tend to obstruct after 6-8 months; then, retreatment requires exchange of the endoprosthesis or establishment of a permanent external-internal biliary drainage which offers, in some patients, a relatively long survival. Percutaneous intraluminal HDR brachytherapy might be a valid alternative as a definitive therapy or as a method to keep metallic stents patent for a long time. Five patients with hilar cholangiocarcinoma, diagnosed by means of ultrasound, Computed Tomography, percutaneous transhepatic cholangiography and transluminal biopsy, underwent double percutaneous external-internal biliary drainage. Dummy sources were introduced into the drainage catheters to allow dose distribution planning. The stepwise progression of the miniaturized high activity Iridium source inside the applicators, introduced into the drainage catheters, was controlled and monitored by a computer equipped with dedicated software. In the radiotherapy bunker, using the remote loading technique, percutaneous intracavitary high dose rate brachytherapy was delivered at the rate of 750 cGy per fraction, prescribed at 1 cm from the center of the catheter, once a week, for 4 weeks. Nevertheless, only 4 of 5 patients underwent the complete treatment. In one case, radiation treatment was discontinued after the first session because of digestive bleeding from a duodenal ulcer, supposingly as a consequence of the decubitus of a catheter tip. CT demonstrated rapid progression of the disease with neoplastic spread to the omentum and gallbladder wall thickening; a gallbladder malignancy was then suspected and the patient was no more eligibile for brachytherapy. Subsequently, Carey-Coons endoprostheses were inserted to prevent post-actinic strictures and removed after three months. After completing radiation therapy, control cholangiograms demonstrated in all cases improvement of neoplastic strictures. The first two patients we treated show no signs of tumor recurrence at 4 and 1 months, respectively, after endoscopic removal of the stents. The third patients is still bearing 2 Carey-Coons endoprostheses to be removed after 3 months. The last patient with supposingly partial success of brachytherapy, was treated with two Strecker nitinol stents. Rapid decrease in initially high levels of tumor markers (Ca 50 and Ca 19-9) were obtained in 2 of 3 patients. No major complications occurred during treatment and to date all patients are alive and well. Long-term results have to be attended and compared with those from the surgical series in order to evaluate the effectiveness of high dose rate brachytherapy.

Original languageItalian
Pages (from-to)79-85
Number of pages7
JournalRadiologia Medica
Volume88
Issue number1-2
Publication statusPublished - 1994

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Klatskin Tumor
Brachytherapy
Stents
Drainage
Catheters
Therapeutics
Gallbladder
Pathologic Constriction
Radiotherapy
Common Hepatic Duct
Iridium
Neoplasms
Omentum
Retreatment
Cholangiocarcinoma
Cholangiography
Tumor Biomarkers
Duodenal Ulcer
Disease Progression
Software

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

TRATTAMENTO PERCUTANEO DEL COLANGIOCARCINOMA ILARE COMPLETATO CON BRACHITERAPIA CON ALTO RATEO DI DOSE. ESPERIENZA NEI PRIMI 5 CASI. / Righi, D.; Maass, J.; Zanon, E.; Tettoni, S.; Orecchia, R.; Lazzari, R.; Ragona, R.; Gandini, G.

In: Radiologia Medica, Vol. 88, No. 1-2, 1994, p. 79-85.

Research output: Contribution to journalArticle

Righi, D. ; Maass, J. ; Zanon, E. ; Tettoni, S. ; Orecchia, R. ; Lazzari, R. ; Ragona, R. ; Gandini, G. / TRATTAMENTO PERCUTANEO DEL COLANGIOCARCINOMA ILARE COMPLETATO CON BRACHITERAPIA CON ALTO RATEO DI DOSE. ESPERIENZA NEI PRIMI 5 CASI. In: Radiologia Medica. 1994 ; Vol. 88, No. 1-2. pp. 79-85.
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abstract = "Cholangiocarcinoma at the confluence of the hepatic ducts (Klatskin tumor) is a slowly growing malignancy with early onset of symptoms and poor outcome since surgery allows radical resection in only a minority of cases. Percutaneously placed biliary stents offer a good palliation, but tend to obstruct after 6-8 months; then, retreatment requires exchange of the endoprosthesis or establishment of a permanent external-internal biliary drainage which offers, in some patients, a relatively long survival. Percutaneous intraluminal HDR brachytherapy might be a valid alternative as a definitive therapy or as a method to keep metallic stents patent for a long time. Five patients with hilar cholangiocarcinoma, diagnosed by means of ultrasound, Computed Tomography, percutaneous transhepatic cholangiography and transluminal biopsy, underwent double percutaneous external-internal biliary drainage. Dummy sources were introduced into the drainage catheters to allow dose distribution planning. The stepwise progression of the miniaturized high activity Iridium source inside the applicators, introduced into the drainage catheters, was controlled and monitored by a computer equipped with dedicated software. In the radiotherapy bunker, using the remote loading technique, percutaneous intracavitary high dose rate brachytherapy was delivered at the rate of 750 cGy per fraction, prescribed at 1 cm from the center of the catheter, once a week, for 4 weeks. Nevertheless, only 4 of 5 patients underwent the complete treatment. In one case, radiation treatment was discontinued after the first session because of digestive bleeding from a duodenal ulcer, supposingly as a consequence of the decubitus of a catheter tip. CT demonstrated rapid progression of the disease with neoplastic spread to the omentum and gallbladder wall thickening; a gallbladder malignancy was then suspected and the patient was no more eligibile for brachytherapy. Subsequently, Carey-Coons endoprostheses were inserted to prevent post-actinic strictures and removed after three months. After completing radiation therapy, control cholangiograms demonstrated in all cases improvement of neoplastic strictures. The first two patients we treated show no signs of tumor recurrence at 4 and 1 months, respectively, after endoscopic removal of the stents. The third patients is still bearing 2 Carey-Coons endoprostheses to be removed after 3 months. The last patient with supposingly partial success of brachytherapy, was treated with two Strecker nitinol stents. Rapid decrease in initially high levels of tumor markers (Ca 50 and Ca 19-9) were obtained in 2 of 3 patients. No major complications occurred during treatment and to date all patients are alive and well. Long-term results have to be attended and compared with those from the surgical series in order to evaluate the effectiveness of high dose rate brachytherapy.",
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