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Title: Intracatheter hyperthermia and iridium-192 radiotherapy in the treatment of bile duct carcinoma

Abstract

We report a case of a patient with locally advanced bile duct carcinoma treated with 4500 cGy external beam radiotherapy, followed 3 weeks later by intracatheter 915 MHz microwave hyperthermia and radiotherapy delivered through a biliary U-tube placed at the time of surgery. Heating was to 43-45 degrees C for 1 hour followed immediately by intracatheter Iridium-192 seeds to deliver 5000 cGy over a 72 hour period. Prior to treatment, a thermal dosimetry study in phantom was conducted, using the same type of U-tube catheter tubing as in the patient. Orthogonal X rays of the patient's porta hepatis region were used to reconstruct the catheter geometry in the phantom. Proper insertion depth was determined thermographically to obtain maximum heating at the center of the tumor. The maximum SAR was 8.8 watts per kilogram per watt input. During the treatment, the average power applied was 30 W. Six months after therapy, the patient is asymptomatic. Although alkaline phosphatase, SGOT and SGPT have remained elevated, bilirubin has returned to normal and computerized tomographic scans and cholangiograms remain stable. A duodenal ulcer developed after therapy and is healing well with conservative medical management. This case demonstrates that hyperthermia applied through biliary drainage cathetersmore » is technically feasible and clinically tolerated. We believe the use of intracatheter hyperthermia in conjunction with external and/or intracatheter radiotherapy in selected patients with unresectable bile duct carcinomas warrants further study.« less

Authors:
; ; ; ; ; ; ; ; ;
Publication Date:
Research Org.:
City of Hope National Medical Center, Duarte, CA (USA)
OSTI Identifier:
5442707
Resource Type:
Journal Article
Journal Name:
Int. J. Radiat. Oncol., Biol. Phys.; (United States)
Additional Journal Information:
Journal Volume: 14:2
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; 61 RADIATION PROTECTION AND DOSIMETRY; 63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.; BILIARY TRACT; CARCINOMAS; RADIOTHERAPY; ALKALINE PHOSPHATASE; BILIRUBIN; DOSIMETRY; HYPERTHERMIA; IRIDIUM 192; LIVER; MICROWAVE RADIATION; PATIENTS; PHANTOMS; RADIATION SOURCE IMPLANTS; AZOLES; BETA DECAY RADIOISOTOPES; BETA-MINUS DECAY RADIOISOTOPES; BETA-PLUS DECAY RADIOISOTOPES; BODY; BODY TEMPERATURE; CARBOXYLIC ACIDS; DAYS LIVING RADIOISOTOPES; DIGESTIVE SYSTEM; DISEASES; ELECTROMAGNETIC RADIATION; ELECTRON CAPTURE RADIOISOTOPES; ENZYMES; ESTERASES; GLANDS; HEAVY NUCLEI; HETEROCYCLIC ACIDS; HETEROCYCLIC COMPOUNDS; HYDROLASES; IMPLANTS; INTERNAL CONVERSION RADIOISOTOPES; IRIDIUM ISOTOPES; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; MEDICINE; MINUTES LIVING RADIOISOTOPES; MOCKUP; NEOPLASMS; NUCLEAR MEDICINE; NUCLEI; ODD-ODD NUCLEI; ORGANIC ACIDS; ORGANIC COMPOUNDS; ORGANIC NITROGEN COMPOUNDS; ORGANS; PHOSPHATASES; PIGMENTS; PYRROLES; RADIATION SOURCES; RADIATIONS; RADIOISOTOPES; RADIOLOGY; STRUCTURAL MODELS; THERAPY; YEARS LIVING RADIOISOTOPES; 550603* - Medicine- External Radiation in Therapy- (1980-); 655003 - Medical Physics- Dosimetry; 560400 - Other Environmental Pollutant Effects

Citation Formats

Wong, J Y, Vora, N L, Chou, C K, McDougall, J A, Chan, K W, Findley, D O, Forell, B W, Luk, K H, Philben, V J, and Beatty, J D. Intracatheter hyperthermia and iridium-192 radiotherapy in the treatment of bile duct carcinoma. United States: N. p., 1988. Web. doi:10.1016/0360-3016(88)90443-9.
Wong, J Y, Vora, N L, Chou, C K, McDougall, J A, Chan, K W, Findley, D O, Forell, B W, Luk, K H, Philben, V J, & Beatty, J D. Intracatheter hyperthermia and iridium-192 radiotherapy in the treatment of bile duct carcinoma. United States. doi:10.1016/0360-3016(88)90443-9.
Wong, J Y, Vora, N L, Chou, C K, McDougall, J A, Chan, K W, Findley, D O, Forell, B W, Luk, K H, Philben, V J, and Beatty, J D. Mon . "Intracatheter hyperthermia and iridium-192 radiotherapy in the treatment of bile duct carcinoma". United States. doi:10.1016/0360-3016(88)90443-9.
@article{osti_5442707,
title = {Intracatheter hyperthermia and iridium-192 radiotherapy in the treatment of bile duct carcinoma},
author = {Wong, J Y and Vora, N L and Chou, C K and McDougall, J A and Chan, K W and Findley, D O and Forell, B W and Luk, K H and Philben, V J and Beatty, J D},
abstractNote = {We report a case of a patient with locally advanced bile duct carcinoma treated with 4500 cGy external beam radiotherapy, followed 3 weeks later by intracatheter 915 MHz microwave hyperthermia and radiotherapy delivered through a biliary U-tube placed at the time of surgery. Heating was to 43-45 degrees C for 1 hour followed immediately by intracatheter Iridium-192 seeds to deliver 5000 cGy over a 72 hour period. Prior to treatment, a thermal dosimetry study in phantom was conducted, using the same type of U-tube catheter tubing as in the patient. Orthogonal X rays of the patient's porta hepatis region were used to reconstruct the catheter geometry in the phantom. Proper insertion depth was determined thermographically to obtain maximum heating at the center of the tumor. The maximum SAR was 8.8 watts per kilogram per watt input. During the treatment, the average power applied was 30 W. Six months after therapy, the patient is asymptomatic. Although alkaline phosphatase, SGOT and SGPT have remained elevated, bilirubin has returned to normal and computerized tomographic scans and cholangiograms remain stable. A duodenal ulcer developed after therapy and is healing well with conservative medical management. This case demonstrates that hyperthermia applied through biliary drainage catheters is technically feasible and clinically tolerated. We believe the use of intracatheter hyperthermia in conjunction with external and/or intracatheter radiotherapy in selected patients with unresectable bile duct carcinomas warrants further study.},
doi = {10.1016/0360-3016(88)90443-9},
journal = {Int. J. Radiat. Oncol., Biol. Phys.; (United States)},
number = ,
volume = 14:2,
place = {United States},
year = {1988},
month = {2}
}