Locoregional recurrence after curative intent resection for intrahepatic cholangiocarcinoma: implications for adjuvant radiotherapy

Backgrounds. As for intrahepatic cholangiocarcinoma, the most frequent site of failure after curative intent resection is the liver. We identified the risk factors for locoregional recurrence after curative intent resection for intrahepatic cholangiocarcinoma. Methods. Medical records of 115 patients treated with surgical resection alone for intrahepatic cholangiocarcinoma from November 2000 to December 2010 were retrospectively reviewed. Locoregional failure was defined as recurrence within 20 mm from resection margin or regional lymph node. Overall survival and locoregional recurrence rates were analyzed using Kaplan–Meier methods, and the prognostic factors were analyzed using Cox proportional hazards model. Results. Median follow-up duration of surviving patients was 61 months (range 8–139). Sixty-six patients had recurrence, and 45 of 66 patients (68 %) had locoregional recurrence. The 5-year overall survival and locoregional control rates were 49.1 and 51.6 %, respectively. ≥T2b disease and R1 resection were associated with locoregional recurrence in multivariate analysis. Patients were divided into two groups whether these risk factors exist or not. The 5-year locoregional control rates of low (no risk factor n = 64) and high (1 or 2 risk factors n = 51) risk groups were 62.5 and 34.7 %, respectively (P = 0.001). Conclusions. After curative intent resection, locoregional control and survival of patients with intrahepatic cholangiocarcinoma were far from satisfactory. Further studies are needed to evaluate the potential benefit of adjuvant locoregional treatment such as radiotherapy for patients with high-risk factors (≥T2b disease or R1 resection) (AU)

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External radiotherapy for biliary decompression of hilar cholangiocarcinoma.

Obstructive jaundice due to hilar cholangiocarcinoma is difficult to decompress because of the location of the tumor. We used external radiation alone for biliary decompression and reviewed its efficacy in this study. Subjects comprised 14 patients diagnosed as having inoperable hilar cholangiocarcinoma by ultrasonography, percutaneous transhepatic cholangiography, and CT scanning. The total bilirubin level on admission ranged from 0.4 to 34.6 mg/dl (mean: 11.0 mg/dl). These patients were irradiated with a 4MeV linear accelerator using parallel opposing fields measuring from 7 x 7 cm to 8 x 10 cm. The total radiation dose ranged from 50 Gy to 60 Gy and in fractions of 1.8-2.0 Gy per day. No patient underwent further biliary decompression after percutaneous transhepatic cholangiography, and irradiation was performed immediately after diagnosis. Eleven of the 14 patients received the full dose of external radiation. Three patients discontinued radiotherapy because of severe vomiting and nausea, pneumonia, and a hemorrhagic gastric ulcer. In 10 of the 11 patients, the serum total bilirubin level returned to normal (p < 0.005) and no cholangitis occurred. Obstructive jaundice recurred in one patient, and serum total bilirubin returned to normal again after further irradiation. Eight of the 11 patients could be discharged from hospital and returned to society. The survival time of the 11 patients ranged from 3 to 25 months and the 12-month survival rate was 50% (Kaplan-Meier method). This study suggests that external radiation therapy is an effective treatment for biliary decompression in patients with unresectable hilar cholangiocarcinoma.

[Correction of metabolic disorders by magnetic-laser irradiation (experimental study)]. / Korrektsiia metabolicheskikh narushenii magnitolazernym oblucheniem (éksperimental'noe issledovanie).

Five series of experiments were conducted on a model of hepatic insufficiency caused by obstructive jaundice to study the effect of semiconductor infrared laser in a range of 800-900 nm with a static magnetic field on some metabolic changes in the organism. Wistar rats weighing 200-250 g were used. The region of the liver was irradiated through an intact epilated skin. The results provide evidence that a definite role in the pathogenesis of hepatic insufficiency is played by intensification of LPO processes and diminution of antioxidant defence which leads, in turn, to reduction of the insulin-receptor interrelations and sharp decrease of hepatic cell metabolism.

[Palliative treatment of inoperable tumors of the efferent bile ducts]. / Palliative Behandlung bei inoperablen Tumoren der ableitenden Gallenwege.

Our method of percutaneous transhepatic cholangiodrainage (PTCD) and radiotherapy shows better results and prognosis in patients with inoperable tumors of the liver, biliary system and pancreas. PTCD was performed in patients with progressive obstructive jaundice due to inoperable tumors to decompress the hepatobiliary system and to reduce jaundice. This was combined with radiotherapy which was performed pre- and postoperatively and without operation. Aim of radiotherapy was to reduce the tumor and also to explore the possibility of radical operation. Radiotherapy was carried out in most patients with Linear accelerator (Linac), and in some with Betatron or Telecobalt 60. In a few cases was chosen: 1) two phase radiotherapy 2) and/or a combination of ray therapies. Inoperable tumors, which can not be excised, should be treated intraoperatively with radiation therapy. Only after a radiation with 3000-4000 rad linac, tumors showed shrinkage in size and at the same microscopic degenerative changes in tumor cells were observed.