RESULTS OF RADIATION-THERAPY IN CARCINOMA OF THE PROXIMAL BILE-DUCT (KLATSKIN TUMOR)
RESULTS OF RADIATION-THERAPY IN CARCINOMA OF THE PROXIMAL BILE-DUCT (KLATSKIN TUMOR)
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DOI：
10.1055/s-2008-1040466
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发表时间：
1990-05-01
影响因子：
4.2
通讯作者：
VANDIJK, JDP
中科院分区：
文献类型：
--
作者：
GONZALEZ, DG;GERARD, JP;VANDIJK, JDP
摘要肝外胆管癌是一种相当罕见的肿瘤。荷兰每年约有850例新病例被诊断出来。Broe和卡梅隆估计大约20%的肝外胆管癌位于肝管分叉处或其上。目前，只有20%至30%的患者被认为是适合手术切除的候选人。不同系列的可切除率在15%到61%之间。5-13尝试根治性切除的患者中位生存期为17 ~ 41个月，3年生存率为33%~ 50%。4~ sX 13.据报道，仅姑息性切除，即手术后留下的肉眼可见的肿瘤或手术标本边缘的显微镜下肿瘤，可获得7至14个月的中位生存期。手术分流或手术放置导管后的平均存活时间为11至16个月。". '5-' 8当仅进行经皮或内窥镜引流时，预后相当差，中位生存期仅为2至4个月。放射治疗在肝外胆管癌中的作用尚未确定。在少数小系列中，肿瘤切除后增加了辅助术后放疗。平均存活率从II到16个月不等。Iwasaky等报道了11例主肝管肿瘤患者术中放疗作为非治愈性切除术的辅助治疗的结果。2年生存率为17%，中位生存期约为13个月。最近，美国开始了一项合作的前瞻性随机研究，以评估外束放疗并辅以虹膜内放疗的作用。
Carcinoma of the extrahepatic bile ducts is a relatively rare tumor. Approximately 850 new cases are diagnosed in The Netherlands each year.'Broe and Cameron'estimated that approximately 20% of all extrahepatic bile duct carcinomas are localized at or above the hepatic duct bif~ rcation.~ At presentation, only 20 to 30% of all patients are considered suitable candidates for surgical resection.'" The resectability rate varied in the different series between 15 and 61%. 5-13 Attempts at curative resection achieved median survival from 17 to 4 1 months, with a 3-year survival rate from 33 to 50%. 4~ sX 13." M edian survival ranging from 7 to 14 months have been reported when only a palliative resection, that is, either macroscopic tumor left after surgery or microscopic tumor in the margins of the surgical specimen, could be perf~ rmed.~.~.'Wedian survival following either surgical bypass or surgically placed catheter was from 1 1 to 16 months.".'5-'8 The prognosis was considerably poorer when only a percutaneous or endoscopic drainage was carried out, with median survival being only 2 to 4 months. I"" The role of radiation therapy in extrahepatic bile duct cancer has not yet been established. In a few small series, adjuvant postoperative irradiation was added following tumor resection.'"" Mean survival rates varied from II to 16 months. Iwasaky et al'have reported the results of intraoperative radiotherapy as adjunct to noncurative resection in 11 patients with tumor in the main hepatic ducts. The 2-year survival rate was 17% and the median survival was about 13 months. Recently, a cooperative prospective randomized study started in the United States to evaluate the role of external beam radiotherapy, supplemented by internal radiotherapy with iri-