Unresectable hilar cholangiocarcinoma: combined percutaneous and radiotherapic treatment

Purpose: To evaluate, in patients with inoperable hilar cholangiocarcinoma (CLCA), the efficacy of multimodality treatment (brachytherapy, chemotherapy, external radiotherapy and endoprosthesis positioning) in terms of survival, quality of life and cost/benefit compared to palliative surgical treatment. Material and methods: 11 of 21 patients with inoperable hilar CLCA were enrolled in the following protocol: percutaneous cholangiography followed by positioning of right and left internal biliary drainage (10-12 F); intraductal brachytherapy (7 Gy); the biliary drainages were then replaced by endoprosthesis (12-14F) and left in position for 3 months; external radiotherapy starting 15 days after last brachitherapy; chemotherapy (5 FU) for 5 days; biliary endoprosthesis were removed by endoscopic or transhepatic mode. Follow-up was by: hepatic lab work-up, tumoral markers, US or CT evaluation. Results: 6 patients completed the protocol and 5 were treated only with brachytherapy. All patients had initial complete remission of jaundice. No acute complication was observed. Digestive hemorrhage was the cause of death in 1 patient. Conclusion: Mean survival was 10.5 months instead of 1.75 months of only percutaneous drainage. The average hospitalization was 10-15 days instead of 15-20 days for palliative biliary-digestive deviation, being less invasive and thus associated with lower morbidity and no mortality. This approach should improve the efficacy of the proposed protocol in terms of quality of life and survival