Klatskin tumor treated by inter-disciplinary therapies including stereotactic radiotherapy: a case report

Abstract

In view of the poor prognosis of patients with cholangiocarcinoma (CCC), there is a need for new therapeutic strategies. Inter-disciplinary therapy seems to be most promising. Radiotherapy is an effective alternative to surgery for hilar CCC (Klatskin tumors) if an adequate radiation dose can be delivered to the liver hilus. Here, we describe a patient for whom we used a stereotactic radiotherapy technique in the context of an inter-disciplinary treatment concept. We report a 45-year-old patient with a locally advanced Klatskin tumor. Explorative laparotomy showed that the tumor was not resectable. A metallic stent was implanted and the patient was treated by stereotactic radiotherapy using a body frame. A total dose of 48 Gy (3X4 Gy/wk) was administered. Therapy was well tolerated. After 32 mo, local tumor recurrence and a chest wall metastasis developed and were controlled by radio-chemotherapy. After more than 56 mo with a good quality of life, the patient died of advanced neoplastic disease. Stereotactic radiotherapy led to a long-term survival of this patient with a locally advanced Klatskin tumor. In the context of inter-disciplinary treatment concepts, this radiotherapy technique is a promising choice of treatment for patients with hilar CCC.

Figure 1

CT slice of radiotherapy treatment plan in the drainage area (planning system: TMS Helax). 1-7: Coplanar beams. Isodoses: green: 100% = 48.0 Gy; light blue 1: 90% = 43.2 Gy; light blue 2: 80% = 38.4 Gy; light blue 3: 70% = 33.6 Gy; dark blue: 50% = 24.0 Gy. A: PTV (planning target volume): outer red line includes a safety rim. B: Body frame (low density materials to avoid shielding) with positioning marks. C: Vacuum cushion for reproducible fixation of the patient (low density materials to avoid shielding: not visible in CT scan). D: Drainage. E: Radio-opaque fiducials for the coordinate read out in longitudinal direction.

Figure 2

Patient’s treatment course from 12/1998 to 08/2003.