Malignant biliary duct obstruction: long-term experience with Gianturco stents and combined-modality radiation therapy.

Eschelman, David J.; Shapiro, Mia; Bonn, Joseph; Sullivan, Kevin L.; Alden, Mark; Hovsepian, David M.; Gardiner, G.A.

doi:10.1148/radiology.200.3.8756921

Cited by 80 publications

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“…Median time from the first percutaneous intervention to the successful implantation of metal stent was 44 days, and the average number of percutaneous sessions totalled 5.2 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). This depended on the favorable effect of percutaneous drainage (for at least 2 weeks, with substantial improvement of laboratory tests), of the technique and the necessary time for histological confirmation of malignant stenosis.…”

Section: Resultsmentioning

confidence: 99%

“…External beam radiotherapy and mainly intraluminal brachytherapy can extend stent patency and therefore the quality and survival of patients. 5,6 The advantage of brachytherapy with 192 Ir is the possibility of delivering higher doses of radiation, in a short time, without significant irradiation of normal tissues. Between the years 1997-2000 we showed the benefit of brachytherapy in prospective randomized study.…”

Section: Introductionmentioning

confidence: 99%

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Multimodal Oncological Therapy Comprising Stents, Brachytherapy, and Regional Chemotherapy for Cholangiocarcinoma

Andrašina¹,

Válek²,

Pánek³

et al. 2010

Gut Liver

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Background/Aims: To prospectively evaluate our palliative management of unresectable cholangiocarcinoma (CC) treated with tailored multimodal oncological therapy. Methods: Between January 2005 and January 2010, 50 consecutive patients with unresectable CC and jaundice were palliated with percutaneous drainage. Forty-three patients underwent metallic-stent implantation followed by brachytherapy. Patients were divided into two arms: the intra-arterial chemotherapy arm (IA arm, n=17) consisted of patients treated with locoregional treatment (IA admission of Cisplatin and 5-fluorouracil, or chemoembolization with Lipiodol) and/or systemic chemotherapy, while the systemic chemotherapy arm (IV arm, n=23) included all the other patients, who were treated only with systemic chemotherapy. Results: In total, 78 metal self-expandable stents were placed. Hilar involvement with mass-forming and periductal infiltrating types of CC (84%) was predominant. The average number of percutaneous interventional procedures was 11.61 per patient (range, 4-35). The median overall survival from diagnosis of disease for all patients was 13.5 months (range, 11.0-18.8 months). The median overall survival times were 25.2 months (range, 15.2-31.3 months) and 11.5 months (range, 8.5-12.6 months) in the IA and IV arms, respectively (p＜0.05). The 1-, 2-, and 3-year survival rates in the IA and IV arms were 88.2%, 52.9%, and 10.1% and 43.5%, 25.4, and 0%, respectively. There were no major complications (WHO III/IV) due to interventional procedures. Conclusions: We could reach acceptable prognosis in patients with unresectable CC using complex tailored oncological therapy. However, the main limitations of prolonging survival are performance status, patient compliance and the maintaining of biliary tract patency. (Gut Liver 2010;4(Suppl. 1):S82-88)

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multimodal Oncological Therapy Comprising Stents, Brachytherapy, and Regional Chemotherapy for Cholangiocarcinoma

Andrašina¹,

Válek²,

Pánek³

et al. 2010

Gut Liver

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“…Although self-expanding metal stent seems to be the first choice in the palliation of MOJ, high rates of stent occlusion, which were mainly caused by tumor ingrowth or overgrowth, usually lead to jaundice recurrence [12,13] . Therefore, treating underlying malignancy is critical to extend stent patency and patient survival.…”

Section: Introductionmentioning

confidence: 99%

HDR-¹⁹²Ir intraluminal brachytherapy in treatment of malignant obstructive jaundice

Chen¹

2004

WJG

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AIM:To determine the feasibility and safety of intraluminal brachytherapy in treatment of malignant obstructive jaundice (MOJ) and to evaluate the clinical effect of intraluminal brachytherapy on stent patency and patient survival. METHODS:Thirty-four patients with MOJ were included in this study. Having biliary stent placed, all patients were classified into intraluminal brachytherapy group (group A, n = 14) and control group (group B, n = 20) according to their own choice. Intraluminal brachytherapy regimen included:

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“…For the palliation of cholangiocarcinoma, the use of the brachytherapy with iridium-192 in combination with conventional drainage has shown promising results and led to extended survival (14). This internal source allows a high local dose of radiation while limiting the exposure of adjacent organs.…”

mentioning

confidence: 99%

Intraluminal Brachytherapy after Metallic Stent Placement in Primary Bile Duct Carcinoma

Park

Cho

Kang

et al. 2001

J Korean Radiol Soc

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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.

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Malignant biliary duct obstruction: long-term experience with Gianturco stents and combined-modality radiation therapy.

Cited by 80 publications

References 0 publications

Multimodal Oncological Therapy Comprising Stents, Brachytherapy, and Regional Chemotherapy for Cholangiocarcinoma

Multimodal Oncological Therapy Comprising Stents, Brachytherapy, and Regional Chemotherapy for Cholangiocarcinoma

HDR-¹⁹²Ir intraluminal brachytherapy in treatment of malignant obstructive jaundice

Intraluminal Brachytherapy after Metallic Stent Placement in Primary Bile Duct Carcinoma

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Malignant biliary duct obstruction: long-term experience with Gianturco stents and combined-modality radiation therapy.

Cited by 80 publications

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Multimodal Oncological Therapy Comprising Stents, Brachytherapy, and Regional Chemotherapy for Cholangiocarcinoma

Multimodal Oncological Therapy Comprising Stents, Brachytherapy, and Regional Chemotherapy for Cholangiocarcinoma

HDR-192Ir intraluminal brachytherapy in treatment of malignant obstructive jaundice

Intraluminal Brachytherapy after Metallic Stent Placement in Primary Bile Duct Carcinoma

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HDR-¹⁹²Ir intraluminal brachytherapy in treatment of malignant obstructive jaundice