CARCINOMA OF THE EXTRAHEPATIC BILIARY SYSTEM - RESULTS OF PRIMARY AND ADJUVANT RADIOTHERAPY
CARCINOMA OF THE EXTRAHEPATIC BILIARY SYSTEM - RESULTS OF PRIMARY AND ADJUVANT RADIOTHERAPY
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DOI：
10.1016/0360-3016(87)90006-x
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发表时间：
1987-03-01
影响因子：
7
通讯作者：
EMAMI, B
中科院分区：
文献类型：
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作者：
FIELDS, JN;EMAMI, B
1975年至1983年间，20名原发性胆囊癌（GB）和肝外胆管癌（EHBD）患者在华盛顿大学医学中心及其附属医院接受了治疗性放射治疗。在 17 名 EHBD 癌症患者中，一名在肉眼切除后接受辅助照射，且镜下切缘呈阳性。所有其他人都针对无法切除的肿瘤或不完全切除后的肉眼残留肿瘤接受了初次放射治疗。与仅接受外部放射治疗的 9 名患者相比，接受 Ir192 植入物加外部放射治疗的 8 名患者的生存期有所改善 (p = 0.06)：中位生存期为 15 个月（范围 1.5-34+ 个月），而中位生存期为 7 个月（范围 2.5-21 个月）。失败主要是局部区域，只有一名患者显示转移扩散，但没有已知的局部区域肿瘤。 3 名 GB 癌患者在胆囊切除术后接受了辅助放射治疗，这些患者的肿瘤已超出浆膜或区域淋巴管。其中，两人存活时间分别为 22 个月以上和 27 个月以上；第三个在 5 1/2 个月时死于局部复发。尽管数字很小，但这些结果似乎支持对显微镜下残留的 GB 癌患者使用辅助放疗。积极的局部和区域放射治疗可以增加两个患者组的生存质量和生存时间，即那些具有高可能性存在微观残留病灶的可切除病灶的患者，以及那些术后具有不可切除或肉眼残留病灶的患者。
From 1975-1983, 20 patients with primary carcinomas of the gallbladder (GB) and extrahepatic bile ducts (EHBD) were irradiated with curative intent at the Washington University Medical Center and affiliated hospitals. Of the 17 patients with EHBD cancer, one received adjuvant irradiation after gross resection with positive microscopic margins. All others received primary irradiation for unresectable tumors, or for gross residual tumor after incomplete resection. The 8 patients receiving Ir192 implant in addition to external radiation showed improved (p = 0.06) survival compared to the 9 receiving external only: median 15 months (range 1.5-34+ months) versus 7 months (range 2.5-21 months). Failures were predominantly local-regional, with only one patient showing metastatic spread without known local-regional tumor. Adjuvant radiation therapy was given after cholecystectomy to 3 patients with GB cancers showing tumor extension beyond the serosa or to regional lymphatics. Of those, two survived at 22+ and 27+ months; the third died of local recurrence at 5 1/2 months. Although numbers are small, these results appear to support the use of adjuvant radiotherapy in patients with microscopic residual GB cancer. Aggressive local and regional radiotherapy can add to the quality and length of survival in both patient groups, that is, those with resectable lesions with high likelihood of microscopic residual, and also those with unresectable or gross residual disease after surgery.