Malignant obstructive jaundice: treatment with external-beam and intracavitary radiotherapy

Journal Article · Fri Feb 01 00:00:00 EST 1985 · Int. J. Radiat. Oncol., Biol. Phys.; (United States)

DOI:https://doi.org/10.1016/0360-3016(85)90166-X· OSTI ID:5724101

Johnson, D W; Safai, C; Goffinet, D R

Eleven patients with obstructive jaundice from unresectable cholangiocarcinoma, metastatic porta hepatis adenopathy, or direct compression from a pancreatic malignancy were treated at the Stanford University Medical Center from 1978-1983 with an external drainage procedure followed by high-dose external-beam radiotherapy and by an intracavitary boost to the site of obstruction with Iridium/sup 192/ (Ir/sup 192/). A median dose of 5000 cGy was delivered with 4-6 Mv photons to the tumor bed and regional lymphatics in 9 patients, 1 patient received 2100 cGy to the liver in accelerated fractions because of extensive intrahepatic disease, and 1 patient received 7000 equivalent cGy to his pancreatic tumor bed and regional lymphatics with neon heavy particles. An Ir/sup 192/ wire source later delivered a 3100-10,647 cGy boost to the site of biliary obstruction in each patient, for a mean combined dose of 10,202 cGy to a point 5 mm from the line source. Few acute complications were noted, but 3/11 patients (27%) subsequently developed upper gastrointestinal bleeding from duodenitis or frank duodenal ulceration 4 weeks, 4 months, and 7.5 months following treatment. Eight patients died - 5 with local recurrence +/- distant metastasis, 2 with sepsis, and 1 with widespread systemic metastasis. Autopsies revealed no evidence of biliary tree obstruction in 3/3 patients. Evolution of radiation treatment technqiues for biliary obstruction in the literature is reviewed. High-dose external-beam therapy followed by high-dose Ir/sup 192/ intracavitary boost is well tolerated and provides significant palliation.

• Research Organization: Stanford Univ. Medical Center, CA
• OSTI ID: 5724101
• Journal Information: Int. J. Radiat. Oncol., Biol. Phys.; (United States), Vol. 11:2
• Country of Publication: United States
• Language: English

Related Subjects

63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.
62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOMAS
RADIOTHERAPY
FIBROSIS
RADIOINDUCTION
HEMORRHAGE
SIDE EFFECTS
ULCERS
BILIARY TRACT
BIOLOGICAL RADIATION EFFECTS
EXTERNAL IRRADIATION
HARD X RADIATION
IRIDIUM 192
JAUNDICE
LIVER
PANCREAS
PATIENTS
RADIATION SOURCE IMPLANTS
SMALL INTESTINE
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
BETA-PLUS DECAY RADIOISOTOPES
BIOLOGICAL EFFECTS
BODY
DAYS LIVING RADIOISOTOPES
DIGESTIVE SYSTEM
DISEASES
ELECTROMAGNETIC RADIATION
ELECTRON CAPTURE RADIOISOTOPES
ENDOCRINE GLANDS
GASTROINTESTINAL TRACT
GLANDS
HEAVY NUCLEI
IMPLANTS
INTERNAL CONVERSION RADIOISOTOPES
INTESTINES
IONIZING RADIATIONS
IRIDIUM ISOTOPES
IRRADIATION
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
MEDICINE
MINUTES LIVING RADIOISOTOPES
NEOPLASMS
NUCLEAR MEDICINE
NUCLEI
ODD-ODD NUCLEI
ORGANS
PATHOLOGICAL CHANGES
RADIATION EFFECTS
RADIATION SOURCES
RADIATIONS
RADIOISOTOPES
RADIOLOGY
SYMPTOMS
THERAPY
X RADIATION
YEARS LIVING RADIOISOTOPES
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