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. 1988 Feb;29(2):149–152. doi: 10.1136/gut.29.2.149

Transpapillary iridium-192 wire in the treatment of malignant bile duct obstruction.

M D Levitt 1, B H Laurence 1, F Cameron 1, P F Klemp 1
PMCID: PMC1433305  PMID: 2831118

Abstract

Twenty four patients with malignant bile duct obstruction were treated with intraluminal radiotherapy using iridium-192 wire inserted through an endoscopically placed nasobiliary catheter. Biliary drainage after treatment was maintained by an endoprosthesis. The median dose of intraluminal radiotherapy was 6000 cGy; two patients with cholangiocarcinoma were given a second course because of disease extension; four patients with pancreatic carcinoma received additional external irradiation (3000 cGy). There was one early death from a cerebrovascular accident (30 day mortality, 4.2%). Cholangitis (30%) was the major early complication and stent blockage (40%) the major late complication; there were no complications directly attributable to radiotherapy. The median survival for patients with pancreatic carcinoma was 250 days and for cholangiocarcinoma, 300 days. This method is technically feasible and may prove safer than the transhepatic technique. The ability of intraluminal irradiation to improve palliation or lengthen survival in patients with malignant bile duct obstruction remains uncertain. Assessment by a prospective, controlled trial is essential.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Basrur V. R., Knight P. R. Intracavitary radiation for rectal carcinoma. J Can Assoc Radiol. 1983 Mar;34(1):42–46. [PubMed] [Google Scholar]
  2. Blumgart L. H., Hadjis N. S., Benjamin I. S., Beazley R. Surgical approaches to cholangiocarcinoma at confluence of hepatic ducts. Lancet. 1984 Jan 14;1(8368):66–70. doi: 10.1016/s0140-6736(84)90002-3. [DOI] [PubMed] [Google Scholar]
  3. Brooks D. C., Osteen R. T., Gray E. B., Jr, Steele G. D., Jr, Wilson R. E. Evaluation of palliative procedures for pancreatic cancer. Am J Surg. 1981 Apr;141(4):430–433. doi: 10.1016/0002-9610(81)90135-5. [DOI] [PubMed] [Google Scholar]
  4. Conroy R. M., Shahbazian A. A., Edwards K. C., Moran E. M., Swingle K. F., Lewis G. J., Pribram H. F. A new method for treating carcinomatous biliary obstruction with intracatheter radium. Cancer. 1982 Apr 1;49(7):1321–1327. doi: 10.1002/1097-0142(19820401)49:7<1321::aid-cncr2820490702>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  5. Cotton P. B., Burney P. G., Mason R. R. Transnasal bile duct catheterisation after endoscopic sphincterotomy: method for biliary drainage, perfusion, and sequential cholangiography. Gut. 1979 Apr;20(4):285–287. doi: 10.1136/gut.20.4.285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Deans T., Rafferty M. W. An autoclavable transport container for guide-wires containing iridium 192. Br J Radiol. 1986 Dec;59(708):1223–1224. doi: 10.1259/0007-1285-59-708-1223. [DOI] [PubMed] [Google Scholar]
  7. Evander A., Fredlund P., Hoevels J., Ihse I., Bengmark S. Evaluation of aggressive surgery for carcinoma of the extrahepatic bile ducts. Ann Surg. 1980 Jan;191(1):23–29. doi: 10.1097/00000658-198001000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Fletcher M. S., Brinkley D., Dawson J. L., Nunnerley H., Wheeler P. G., Williams R. Treatment of high bileduct carcinoma by internal radiotherapy with iridium-192 wire. Lancet. 1981 Jul 25;2(8239):172–174. doi: 10.1016/s0140-6736(81)90357-3. [DOI] [PubMed] [Google Scholar]
  9. Herskovic A., Heaston D., Engler M. J., Fishburn R. I., Jones R. S., Noell K. T. Irradiation of biliary carcinoma. Radiology. 1981 Apr;139(1):219–222. doi: 10.1148/radiology.139.1.7208926. [DOI] [PubMed] [Google Scholar]
  10. Huibregtse K., Katon R. M., Coene P. P., Tytgat G. N. Endoscopic palliative treatment in pancreatic cancer. Gastrointest Endosc. 1986 Oct;32(5):334–338. doi: 10.1016/s0016-5107(86)71878-6. [DOI] [PubMed] [Google Scholar]
  11. Ikeda H., Kuroda C., Uchida H., Miyata Y., Masaki N., Shigematsu Y., Monden M., Okamura J. [Intraluminal irradiation with iridium-192 wires for extrahepatic bile duct carcinoma--a preliminary report (author's transl)]. Nihon Igaku Hoshasen Gakkai Zasshi. 1979 Dec 25;39(12):1356–1358. [PubMed] [Google Scholar]
  12. Karani J., Fletcher M., Brinkley D., Dawson J. L., Williams R., Nunnerley H. Internal biliary drainage and local radiotherapy with iridium-192 wire in treatment of hilar cholangiocarcinoma. Clin Radiol. 1985 Nov;36(6):603–606. doi: 10.1016/s0009-9260(85)80242-7. [DOI] [PubMed] [Google Scholar]
  13. Laurence B. H., Cotton P. B. Decompression of malignant biliary obstruction by duodenoscopic intubation of bile duct. Br Med J. 1980 Feb 23;280(6213):522–523. doi: 10.1136/bmj.280.6213.522. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Molt P., Hopfan S., Watson R. C., Botet J. F., Brennan M. F. Intraluminal radiation therapy in the management of malignant biliary obstruction. Cancer. 1986 Feb 1;57(3):536–544. doi: 10.1002/1097-0142(19860201)57:3<536::aid-cncr2820570322>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  15. Mornex F., Gerard J. P., Bret P., Partensky C. Iridium wire radiotherapy for high bileduct carcinoma. Lancet. 1981 Aug 29;2(8244):479–479. doi: 10.1016/s0140-6736(81)90820-5. [DOI] [PubMed] [Google Scholar]
  16. Morrow M., Hilaris B., Brennan M. F. Comparison of conventional surgical resection, radioactive implantation, and bypass procedures for exocrine carcinoma of the pancreas 1975-1980. Ann Surg. 1984 Jan;199(1):1–5. doi: 10.1097/00000658-198401000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Phillip J., Hagenmüller F., Manegold K., Szepesi S., Classen M. Endoskopische, intraduktale Strahlentherapie hochsitzender Gallengangskarzinome. Dtsch Med Wochenschr. 1984 Mar 16;109(11):422–426. doi: 10.1055/s-2008-1069206. [DOI] [PubMed] [Google Scholar]
  18. Pierquin B., Dutreix A., Paine C. H., Chassagne D., Marinello G., Ash D. The Paris system in interstitial radiation therapy. Acta Radiol Oncol Radiat Phys Biol. 1978;17(1):33–48. doi: 10.3109/02841867809127689. [DOI] [PubMed] [Google Scholar]
  19. Rowland C. G., Pagliero K. M. Intracavitary irradiation in palliation of carcinoma of oesophagus and cardia. Lancet. 1985 Nov 2;2(8462):981–983. doi: 10.1016/s0140-6736(85)90527-6. [DOI] [PubMed] [Google Scholar]
  20. Tompkins R. K., Thomas D., Wile A., Longmire W. P., Jr Prognostic factors in bile duct carcinoma: analysis of 96 cases. Ann Surg. 1981 Oct;194(4):447–457. doi: 10.1097/00000658-198110000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. van Heerden J. A., Heath P. M., Alden C. R. Biliary bypass for ductal adenocarcinoma of the pancreas: Mayo Clinic experience, 1970-1975. Mayo Clin Proc. 1980 Sep;55(9):537–540. [PubMed] [Google Scholar]

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