Radiation therapy and photodynamic therapy for biliary tract and ampullary carcinomas.
Radiation therapy and photodynamic therapy for biliary tract and ampullary carcinomas.
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DOI：
10.1007/s00534-007-1281-y
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Miura, Fumihiko
中科院分区：
文献类型：
--
作者：
Saito, Hiroya;Takada, Tadahiro;Miyazaki, Masaru;Miyakawa, Shuichi;Tsukada, Kazuhiro;Nagino, Masato;Kondo, Satoshi;Furuse, Junji;Tsuyuguchi, Toshio;Kimura, Fumio;Yoshitomi, Hideyuki;Nozawa, Satoshi;Yoshida, Masahiro;Wada, Keita;Amano, Hodaka;Miura, Fumihiko
关键词：
放射治疗不能切除的胆道癌的目的是延长生存期或延长支架通畅率，并缓解疼痛。对于不能切除的胆管癌，有许多研究表明，放射治疗优于最好的支持性治疗。虽然放射治疗在许多机构中使用，但到目前为止还没有进行大型随机对照试验(RCT)，支持这种治疗优越性的证据水平很低。因为不使用胆道支架很难长期缓解黄疸，所以通常采用放射治疗和支架置入相结合的方法。作为放射治疗，通常采用外照射，但腔内近距离照射与外照射相结合更有利于提高治疗效果。有许多报告表明，通过这种联合治疗，可以提高应答率，延长生存期和复发时间。尽管证据水平较低，但许多机构都在进行这种联合疗法。预计将开展多机构区域协调机制。不能切除的大病灶胆囊癌通常是广泛的，与之毗邻的是具有高放射敏感性的正常器官。因此，对于这种类型的癌症，外照射治疗只能产生有限的抗癌效果。关于壶腹癌的报告数量很少，放射治疗在这种癌症中的作用还没有确定。壶腹癌的综合治疗包括单独使用术中放射治疗、术后外照射或腔内放射治疗，或两种或三种治疗方法的组合。术中放射治疗的优势在于它能够精确地照射到目标部位，从而保护邻近对辐射高度敏感的正常组织免受照射。有报告显示，与未接受放射治疗的患者相比，接受术中或术后放射治疗的患者存活率延长，但并不显著。到目前为止，还没有关于放射治疗作为术后辅助治疗的重要性的大型随机对照试验的报道，因此它作为术后辅助治疗的有效性还没有得到证实。另一种治疗方法是光动力疗法。一项随机对照试验表明，与单独使用胆道支架相比，光动力疗法与胆道支架置入术相结合，可延长不能切除的胆道癌患者的生存期，提高患者的生活质量。大型随机对照试验的结果是可取的。
The purpose of radiation therapy for unresectable biliary tract cancer is to prolong survival or prolong stent patency, and to provide palliation of pain. For unresectable bile duct cancer, there are a number of studies showing that radiation therapy is superior to the best supportive care. Although radiation therapy is used in many institutions, no large randomized controlled trials (RCTs) have been performed to date and the evidence level supporting the superiority of this treatment is low. Because long-term relief of jaundice is difficult without using biliary stenting, a combination of radiation therapy and stent placement is commonly used. As radiation therapy, external-beam radiation therapy is usually performed, but combined use of intraluminal brachytherapy with external beam radiation therapy is more useful for making the treatment more effective. There are many reports demonstrating improved response rates as well as extended survival and time to recurrence achieved by this combination therapy. Despite the low level of the evidence, this combination therapy is performed at many institutions. It is expected that multiinstitutional RCTs will be carried out. Unresectable gallbladder cancer with a large focus is usually extensive, and normal organs with high radio sensitivity exist contiguously with it. Therefore, only limited anticancer effects are to be expected from external beam radiation therapy for this type of cancer. The number of reports on ampullary cancer is small and the role of radiation therapy in this cancer has not been established. Combination treatment for ampullary cancer consists of either a single use of intraoperative radiation therapy, postoperative external beam radiation therapy or intraluminal brachytherapy, or a combination of two or three of these therapies. Intraoperative radiation therapy is superior in that it enables precise irradiation to the target site, thereby protecting adjacent highly radiosensitive normal tissues from irradiation. There are reports showing extended survival, although not significant, in groups undergoing intraoperative or postoperative radiation therapy compared with groups without radiation therapy. To date, there are no reports of large RCTs focusing on the significance of radiation therapy as a postoperative adjuvant treatment, so its usefulness as a postoperative adjuvant treatment is not proven. An alternative treatment is photodynamic therapy. There is an RCT demonstrating that, in unresectable bile duct cancer, extended survival and improved quality of life (QOL) have been achieved through a combination of photodynamic therapy and biliary stenting, compared with biliary stenting alone. Results from large RCTs are desired.
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DOI：
10.1016/0360-3016(87)90006-x
发表时间：
1987-03-01
影响因子：
7
作者：
FIELDS, JN;EMAMI, B
通讯作者：
EMAMI, B
影响因子：
9
作者：
PITT, HA;NAKEEB, A;CAMERON, JL
通讯作者：
CAMERON, JL
DOI：
10.1097/00000421-199110000-00014
发表时间：
1991-10-01
影响因子：
2.6
作者：
MINSKY, BD;KEMENY, N;BOTET, J
通讯作者：
BOTET, J
影响因子：
8.8
作者：
Okusaka, T;Ito, Y;Ikeda, H
通讯作者：
Ikeda, H
影响因子：
29.4
作者：
Ortner, MEJ;Caca, K;Lochs, H
通讯作者：
Lochs, H