EXTRAHEPATIC BILIARY SYSTEM CANCER - AN UPDATE OF A COMBINED MODALITY APPROACH
EXTRAHEPATIC BILIARY SYSTEM CANCER - AN UPDATE OF A COMBINED MODALITY APPROACH
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DOI：
10.1097/00000421-199110000-00014
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发表时间：
1991-10-01
影响因子：
2.6
通讯作者：
BOTET, J
中科院分区：
文献类型：
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作者：
MINSKY, BD;KEMENY, N;BOTET, J
自1985年1月以来，12例局部/区域性肝外胆道系统癌（2例：胆囊癌; 5例：Klatskin癌; 5例：胆总管癌）接受了综合治疗。 5例患者进行了内镜逆行胰胆管造影、经皮穿刺胆管造影和胆道引流，7例患者接受了剖腹手术和活检或次全切除术。 所有患者最初接受了5,000 cGy的肿瘤床和原发性淋巴结区域，10名患者接受了额外的1,500 cGy的肿瘤床增强。 化疗（5-氟尿嘧啶/丝裂霉素-C）在每个放射治疗疗程开始时进行。 4例患者接受了额外的1-4个周期的维持化疗，7例接受了近距离放射治疗的加强治疗。 中位生存期为17个月，总的4年精算生存率为36%。 4例患者分别在16、30、48和64个月时没有疾病证据。 作为失败组成部分的失败模式为局部/区域进展，50%;腹部失败，58%;远端失败，8%。 在发生失败的8例患者中，6例发生局部/区域进展。 我们的数据继续表明，这种方法是可行的，并可能导致生存率的改善。 需要继续采取后续行动，以确定这一积极做法的最终影响。
Since January 1985, 12 patients with local/regional extrahepatic biliary system cancer (2: gallbladder; 5: Klatskin; and 5: common bile duct) underwent combined modality therapy. An endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiogram, and biliary drainage were performed in 5 patients, and 7 patients underwent laparotomy and biopsy or subtotal resection. All patients initially received 5,000 cGy to the tumor bed and primary nodal area and 10 received an additional 1,500-cGy boost to the tumor bed. Chemotherapy (5-fluorouracil/mitomycin-C) was delivered at the beginning of each radiation treatment course. Four patients received an additional 1-4 cycles of maintenance chemotherapy and 7 received a boost with brachytherapy. The median survival was 17 months and the overall 4-year actuarial survival was 36%. Four patients have no evidence of disease at 16, 30, 48, and 64 months, respectively. The patterns of failure as a component of failure were local/ regional progression, 50%; abdominal failure, 58%; and distant failure, 8%. Of the 8 patients who developed failure, 6 developed a component of local/regional progression. Our data continue to show that this approach is feasible and may result in an improvement in survival. Continued follow-up will be needed to determine the ultimate impact of this aggressive approach.