Unresectable perihilar cholangiocarcinoma: multimodal palliative treatment

Abstract

Aim: To evaluate the survival of patients with unresectable perihilar cholangiocarcinoma (PHC) treated with multimodal palliative approaches.

Patients and methods: thirty-two patients were enrolled in a multimodal protocol including: bilateral biliary drainage; Yridium-192 intraluminal brachytherapy (BT); metal biliary stenting; external-beam radiotherapy (EBRT); systemic chemotherapy (ChT). All patients underwent BT and biliary stenting: this was the only treatment for 14 patients, it was combined with EBRT in 11, and with EBRT and ChT in seven. Mean and median survival, complication rates and duration of hospital stay were calculated for each group.

Results: BT with EBRT and ChT obtained the best median (15 months) and one year (71.42%) survival followed by BT with EBRT (14 months and 63.63%, respectively). BT with EBRT in a total dose of 54-60 Gy, with or without ChT, led to a significantly higher median survival rate (14 months) than that for BT alone (seven months).

Conclusion: BT with EBRT, with or without ChT, improves survival and should be considered as a suitable alternative to palliative surgery for patients with unresectable perihilar cholangiocarcinoma.

Keywords: Biliary tract neoplasms; Yridium radioisotopes; brachytherapy; expandable metallic stents; radiotherapy.