System Evaluation of Intraluminal Brachytherapy (ILBT) Combined with Endoprostheses Comparied with Endoprostheses alone for Nonresectable Bile Duct Cancer_Chinese Journal of Evidence-Based Medicine

Authors：

HUANG Xin ¹ ,  WU Taixiang ²

1. West China Hospital of Sichuan University, Chengdu 610041, China;2. Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

WU Taixiang, Email: txwutx@hotmail.com

Keywords：

Intraluminal brachytherapy therapy; Unresectable bile duct cancer; Effectiveness; Systematic review

DOI：

10.7507/1672-2531.20090046

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Objective 　To evaluate the effectiveness and safety of intraluminal brachytherapy (ILBT) in prolonging survival and the period free of symptoms for patients with unresectable bile duct cancer.
Methods 　We searched MEDLINE (1977 to May 2007), CNKI (1979 to May 2007) and CBM Disk (1979 to May 2007). The qual ity of included studies was assessed according to the guidance in the Cochrane Handbook for Systematic Reviews of Interventions.
Results 　One randomized controlled trial involving 42 patients with unresectable bile duct cancer fulfilled the inclusion criteria. This found that the median survival time was longer for patients treated with endoprostheses and ILBT compared to those treated with endoprostheses alone (387.9 days versus 298.0 days, P lt;0.05). The stent patency time in patients who were treated with endoprostheses and ILBT was longer than for those treated with endoprostheses alone (378.4 days versus 245.5 days, P lt;0.01). The reductions in bil irubin (mol/l) and alkal ine phosphatase (kat/l) before and after drainage in patients who were treated with endoprostheses and ILBT were similar to those treated with endoprostheses alone (Mean ±SD of bil irubin: before: 219.3 ± 40.5, after: 23.1 ± 37.1 versus before: 227.3 ± 39.8, after: 22.5 ± 44.2; Mean ± SD of alkal ine phosphatase: before: 10.3 ± 5.1. after: 3.6 ± 2.9 versus before: 11.7 ± 5.8, after: 3.7 ± 2.9). No severe adverse effects were observed in the trial.
Conclusion 　 Current evidence suggests that ILBT for unresectable bile duct cancer may improve the survival time of patients, prolong the time they spend symptom free, improve their quality of l ife and reduce the burden of treatment. However, it may increase toxicity in normal tissues, which can be managed by adjusting radiation dosage. No serious adverse effects were observed in the 42 patients in the trial in this review. More randomized controlled trials with large sample size are needed to provide rel iable results.

Citation： HUANG Xin,WU Taixiang. System Evaluation of Intraluminal Brachytherapy (ILBT) Combined with Endoprostheses Comparied with Endoprostheses alone for Nonresectable Bile Duct Cancer. Chinese Journal of Evidence-Based Medicine, 2009, 09(2): 239-242. doi: 10.7507/1672-2531.20090046 Copy

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3.	de Groen PC, Gores GJ, LaRusso NF, et al. Bil iary tract cancers. N Engl J Med, 1999, 341: 1368-1378.
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9.	Berr F, Wiedmann M, Tannapfel A, et al. Photodynamic therapy for advanced bile duct cancer: evidence for improved pall iation and extended survival. Hepatology, 2000, 31(2): 291-298.
10.	Wiedmann M, Berr F, Schiefke I, et al. Photodynamic therapy in patients with non-resectable hilar cholangiocarcinoma: 5-year follow-up of a prospective phase II study. Gaqstrointestinal Endoscopy, 2004, 60(1): 68-75.
11.	Zoepf T, Jakobs R, Arnold JC, et al. Photodynamic therapy for pall iation of nonresectable bile duct cancer --prel iminary results with a new diode laser system. An J Gastroenterol, 2001, 96(7): 2093-2097.

1. V´alek V, Kysela P, Kala Z, et al. Brachytherapy and percutaneous stenting in the treatment of cholangio carcinoma: a prospective randomized study. European Journal of Radiology, 2007, 62: 175-179.
2. Anderson CD, Pinson CW, Berl in J, et al. Diagnosis and treatment of cholangiocarcinoma. Oncologist, 2004, 9(1): 43-57.
3. de Groen PC, Gores GJ, LaRusso NF, et al. Bil iary tract cancers. N Engl J Med, 1999, 341: 1368-1378.
4. Chamberlain RS, Blumgart LH. Hilar cholangiocarcinoma: a review and commentary. Ann Surg Oncol, 2000, 7: 55-66.
5. SpeerAG, CottonPB, MacRaeKD. Endoscopic management of mal ignant bil iary obstruction: Stents of 10 Frenchgaugeare preferable to stents of 8 Frenchgauge. Gastrointest Endosc, 1988, 34: 412-417.
6. Polydorou AA, Cairns SR, Dowsett JF, et al. Pall iation of proximal mal ignant bil iary obstruction by endoscopicen-doprosthesis insertion. Gut, 1991, 32: 685-689.
7. McCaughan JS Jr, Mertens BF, Cho C, et al. Photodynamic therapy to treat tumors of the extrahepatic bil iary ducts. Acase report. Arch Surg, 1991, 126(1): 111-113.
8. Ortner MA, Liebetruth J, Schreiber S, et al. Photodynamic therapy of nonresectable cholangiocarchinoma. Gastroenterology, 1998, 114(3): 536-542.
9. Berr F, Wiedmann M, Tannapfel A, et al. Photodynamic therapy for advanced bile duct cancer: evidence for improved pall iation and extended survival. Hepatology, 2000, 31(2): 291-298.
10. Wiedmann M, Berr F, Schiefke I, et al. Photodynamic therapy in patients with non-resectable hilar cholangiocarcinoma: 5-year follow-up of a prospective phase II study. Gaqstrointestinal Endoscopy, 2004, 60(1): 68-75.
11. Zoepf T, Jakobs R, Arnold JC, et al. Photodynamic therapy for pall iation of nonresectable bile duct cancer --prel iminary results with a new diode laser system. An J Gastroenterol, 2001, 96(7): 2093-2097.

Chinese Journal of Evidence-Based Medicine

System Evaluation of Intraluminal Brachytherapy (ILBT) Combined with Endoprostheses Comparied with Endoprostheses alone for Nonresectable Bile Duct Cancer

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