Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

Abstract

Abstract. Hilar cholangiocarcinoma is often unresectable at the time of the initial diagnosis, and the provision of a definite palliative benefit is important in patients with unresectable hilar cholangiocarcinoma. The aim of the present study was to evaluate the safety of percutaneous biliary stenting and to analyze whether percutaneous biliary stenting combined with radiotherapy (RT) prolonged the stent patency and survival time of patients. In total, the cases of 38 patients with unresectable hilar cholangiocarcinoma that underwent percutaneous biliary stenting at the Navy General Hospital were retrospectively reviewed in the present study. Uncovered metallic stenting (UMS) combined with RT was administered to 25 patients, and UMS alone was administered to 13 patients. The records of early complications subsequent to percutaneous biliary stenting were collected, and the stent patency and survival times of patients were analyzed and compared between the two groups. The technical success rate of the procedure was 100% and the successful drainage rate was 86.8%. The overall early complication rate was 15.8% and the procedure-associated mortality rate was 2.6%. The median stent patency was 326 days in the UMS+RT group and 196 days in the UMS group (P= 0.022). The UMS+RT group (median, 367 days) demonstrated a longer survival time compared with the UMS group (median, 267 days; P= 0.025). Percutaneous biliary stenting offers a safe and effective method for the palliative treatment of patients with unresectable hilar cholangiocarcinoma, and percutaneous biliary stenting combined with RT may prolong stent patency and patient survival time.

Safety and efficacy of irreversible electroporation in the treatment of obstructive jaundice in advanced hilar cholangiocarcinoma

“…27 Tan et al palliated advanced HC with uncovered metal stenting (UMS) combined with radiotherapy (UMS + RT). 28 They demonstrated a median stent patency of 326 days (range, 228-506) in the UMS + RT group and 196 days (range, 139-395) in the UMS only group. 28 These methods were effective for increasing stent patency in this patient population; however, they were not able to remove stents or catheters like the IRE treatment is able to provide.…”

“…28 They demonstrated a median stent patency of 326 days (range, 228-506) in the UMS + RT group and 196 days (range, 139-395) in the UMS only group. 28 These methods were effective for increasing stent patency in this patient population; however, they were not able to remove stents or catheters like the IRE treatment is able to provide. This study should be interpreted in light of several limitations.…”

Interventional Treatment Methods, Fluorescent Diagnostic and Photodynamic Therapy of Nonresectable Cholangiocarcinoma Complicated by Jaundice

“…Однако, большой проблемой является прорастание опухолью непокрытого стента или распространение опухолевой инфильтрации за его границы. Это приводит к повторной механической желтухе [6,9,23]. В подобной ситуации способы воздействия непосредственно на опухоль с целью стабилизации процесса или хотя бы замедления прогрессирования в настоящее время ограничены.…”

“…У 5 больных (18%) с опухолью Клатскина технически не удалось взять материал. С трудностями биопсии опухоли данной локализации сталкивались и другие авторы [9,23].…”

“…Установка покрытого стента в этом случае вызывала риск блокирования стентом сегментарных протоков. Это вынужденная мера, так как известно, что непокрытый стент может быстро обтурироваться опухолью, что требует повторного желчеотведения [9,22]. Однако ФДТ снижает эти риски, о чем свидетельствуют полученные нами результаты, при которых увеличивается межжелтушный период, продолжительность жизни и снижается риск облитерации стента опухолью.…”