Intraluminal Brachytherapy after Metallic Stent Placement in Primary Bile Duct Carcinoma

Abstract

Self-expandable metallic stent placement was introduced in an attempt to overcome the limitations of external biliary drainage catheters (such as tube dislodgement, bile leakage, and psychologic problems) and plastic endoprostheses (such as migration, occlusion, and a traumatic implantation procedure) in treating patients Purpose: To determine the effect of intraluminal brachytherapy on stent patency and survival after metallic stent placement in patients with primary bile duct carcinoma. Materials and Methods: Twenty-seven patients with primary bile duct carcinoma underwent metallic stent placement; in 16 of the 27 intraluminal brachytherapy with an iridium-192 source (dose, 25 Gy) was the performed. Obstruction was due to either hilar (n=14) or non-hilar involvement (n=13). For statistical comparison of patients who underwent/did not undergo intraluminal brachytherapy, stent patency and survival were calculated using the Kaplan-Meier method and an independent t test. Results: The mean durations of stent patency and survival were 9.1 and 10.0 months respectively in patients who underwent intraluminal brachytherapy, and 4.2 and 5.0 months in those who did not undergo this procedure (p<0.05). The mean durations of stent patency and survival among the 22 patients who died were 7.6 (range, 0.8 16.1) and 8.3 (range, 0.8 17.3) months, respectively, in the eleven patients who underwent intraluminal brachytherapy, and 4.2 (range, 0.9 8.0) and 5.0 (range, 0.9 8.4) months in those whom the procedure was not performed (p<0.05). Conclusion: Intraluminal brachytherapy after stent placement extended both stent patency and survival in patients with primary bile duct carcinoma.