Malignant obstructive jaundice – brachytherapy as a tool for palliation

Abstract

PurposeMalignant obstructive jaundice (MOJ) is relieved by stenting via endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography and biliary drainage (PTCD). Stent occlusion rates of 30-45% have been reported in literature due to tumor ingrowth or overgrowth. We prospectively evaluated the feasibility and the role of intraluminal brachytherapy (ILBT) in preventing stent blockage in patients with MOJ after PTCD and stenting.Material and methodsTwelve patients with MOJ who underwent PTCD followed by self expanding metallic stent (SEMS) placement were prospectively enrolled in this study. Written informed consent was obtained. Intraluminal brachytherapy was done once patient was stable and serum bilirubin was less than 2 mg% or 50% of baseline value. On the day of ILBT, 6 French brachytherapy catheters were placed across malignant stricture under fluoroscopic guidance with placement of the tip 1 cm distal to stricture. A dose of 10 to 14 Gy was delivered at 1 cm from central axis of the source. Suitable patients also received external beam radiotherapy (EBRT) with weekly concurrent chemotherapy.ResultsAll patients tolerated the procedure well with minimal acute and late toxicities. Duodenal ulceration was observed in 1 patient. At a mean follow up of 10.25 months (5-24 months), stents were patent in 10/12 subjects and stent patency duration of 9.8 months (5-22) was reported.ConclusionsIntraluminal brachytherapy post PTCD is feasible and effective in preventing stent occlusion with minimal acute and late toxicities.

The efficacy of the combination of percutaneous transhepatic biliary drainage and 125I stranded seeds for malignant bile duct obstruction treatment

“…The exact causes of stent dysfunction were unclear. In addition, irradiation stents cannot be immediately withdrawn in any instance, as intracavitary brachytherapy-related complications can occur [6,24]. In our department, 58 patients diagnosed with MBO were enrolled in this study.…”

“…Patients were followed up after the procedure and subsequent factors were recorded: treatment-related toxicity, bilirubin and tumor markers, biliary obstruction-free time, and survival time. Treatment-related toxicity was assessed according to the National Cancer Institute's Common Terminology Criteria for adverse events (CTCAE, version 4.0) [6]. Imaging and laboratory tests were performed preoperatively and at week 1, and 1-and 3-months post-operation.…”

“…Adequate biliary drainage was the first selective palliative treatment method developed for patients with MBO, and some guidelines recommend the percutaneous approach over endoscopic retrograde cholangiography (ERC) for Bismuth type 3 and 4 hilar strictures [5]. However, this treatment has no therapeutic effect on tumors [6,7]. In recent years, intracavitary brachytherapy has been widely applied clinically, especially in patients with MBO [8].…”

Clinical Study on Using 125I Seeds Articles Combined with Biliary Stent Implantation in the Treatment of Malignant Obstructive Jaundice

“…Biliary stent implantation for the treatment of malignant obstructive jaundice is known to improve the patients' quality of life, prolong survival time and prepare and provide conditions for further chemotherapy, radiotherapy and other treatments (8)(9)(10). However, stent restenosis has become a major limiting factor to providing a lasting benefit.…”

Brachytherapy in India – a long road ahead

“…The other well explored field is that of head and neck cancers, with the goal of delivering conformal therapy in the form of brachytherapy [ 33 ]. A quick look into the brachytherapy articles over the past few years gives a glimpse of their activity in the form of publications for diverse sites like anal cancers [ 34 ], early stage penile cancers [ 35 ], and even less explored organs such as the hepatobiliary malignancies [ 36 – 38 ]. There has been a surge in the quality and quantity of publications relating to brachytherapy from India in the last few years.…”