Conventional radiotherapy in inoperable cholangiocarcinoma is limited by radiotolerance of the surrounding tissues. The aim of our dosimetric study was an evaluation of intensity-modulated radiotherapy in the treatment of inoperable bile duct carcinoma.
Methods
Four patients with inoperable cholangiocarcinoma treated by self-expandable stent placed to the biliary tree and radiotherapy were studied. The rotational technique, conformal 3D BOX technique and intensity-modulated radiotherapy plan were compared. Dose volume histograms and the normal tissue complication probability concept were used for comparison. The stent was used for target motion verification.
Results
The intensity-modulated radiotherapy plans showed favorable dose distribution in planning target volume and remarkable sparing of organs at risk.
Conclusions
The intensity-modulated radiotherapy technique in bile duct carcinomas deserves further research and clinical evaluation.
HannaS.S., RiderW.D.: Carcinoma of the gallbladder or extrahepatic bile ducts: the role of radiotherapy.Can Med Assoc J,118: 59–61, 1978.
2.
PilepichM.V., LambertP.M.: Radiotherapy of carcinomas of the extrahepatic biliary system.Radiology,127: 767–770, 1978.
3.
FletcherM.S., BrinkleyD., DawsonJ.L.: Treatment of hilar carcinoma by bill drainage combined with internal radiotherapy using Iridium-192 wire.Br J Surg,70: 733–735, 1983.
4.
AldenM.F., MohiuddinM.: The impact of radiation dose in combined external beam and intraluminal Ir-192 brachytherapy for bile duct cancer.Int J Radiat Oncol Biol Phys,28: 945–951, 1994.
5.
BourasN., CaudryM., ArieJ., BonnelC., RullierE., TrouetteR., DemeausH., MaireJ.P.: Radiothérapie conformationnelle des cholangiocarcinomes de la voie biliaire principale localement evolues.Cancer/Radiother,6: 22–29, 2002.
6.
LymanJ.T., WolbarstA.B.: Optimization of radiation therapy, III: A method of assessing complication probabilities from dose-volume histograms.Int J Radiat Oncol Biol Phys,13: 103–109, 1987.
Gonzales GonzalesD., GerardJ.P., ManersA.W., De la Lande-GuyauxB., Van Dijk-MilatzA., MeerwaldtJ.H., BossetJ.F., Van DijkJ.D.: Results of radiation therapy in carcinoma of the proximal bile duct (Klatskin tumor).Semin Liver Dis,10: 131–141, 1990.
11.
Gonzales GonzalesD., GoumaD.J., RauwsE.A., van GulikZ.M., BosmaA., KoedooderC.: Role of radiotherapy, in particular intraluminal brachytherapy, in the treatment of proximal bile duct carcinoma.Ann Oncol,10: 215–220, 1999.
12.
MilellaM., SalvettiM., Cerrota, CozziG., UslenghiE., TavolaA., GardaniG., SeveriniA.: Interventional radiology and radiotherapy for inoperable cholangiocarcinoma of the extrahepatic bile ducts.Tumori,84: 467–471, 1998.
13.
McGinnC.J., Ten HakenR.K., EnsmingerW.D., WalkerS., WangS., LawrenceT.S.: Treatment of intrahepatic cancers with radiation doses based on a normal tissue complication probability model.J Clin Oncol,16: 2246–2252, 1998.
14.
LandryJ.C., YangG.Y., TingJ.Y., StaleyC.A., TorresW., EsiashviliN., DavisL.W.: Treatment of pancreatic cancer tumors with intensity-modulated radiation therapy (IMRT) using the volume at risk approach (VARA): Employing dose-volume histoGram (DVH) and normal tissue complication probability (NTCP) to evaluate small bowel toxicity.Med Dosim,27: 121–129, 2002.
15.
LandryJ.C., EsiashviliN., TingJ., StaleyC.: Intensity modulated radiation therapy employing the volume at risk approach to minimize small bowel and renal toxicity when treating patients with locally advanced pancreatic carcinomas [Abstract].Int J Radiat Oncol Biol Phys,51: 270, 2001.
16.
CraneC.H., AntolakJ.A., RosenI.I., ForsterK.M., EvansD.B., JanjanN.A., CharnsangavejC., PistersP.W., LenziR., PapagikosM.A., WolffR.A.: Phase I study of concomitant gemcitabine and IMRT for patients with unresectable adenocarcinoma of the pancreatic head.Int J Gastrointest Cancer,30: 123–132, 2001.
