Internal radiation for bile duct cancer

The clinical course of 27 patients with bile duct cancer who received intraductal exposure to192iridium was reviewed. All patients exhibited evidence of biliary obstruction prior to diagnosis of cancer and all underwent intubation for relief of obstruction either by surgical or radiologic methods. The patients then received either internal irradiation alone or the combination of internal plus external irradiation. The patients lived an average of 11.5 months following internal irradiation and 13.5 months following diagnosis. Patients who received both internal and external irradiation lived longer than those who received internal irradiation alone. The 3 patients who had resection of their primary tumors lived longer than the group as a whole. All patients continued episodes of mild or severe cholangitis following irradiation. The heterogeneity of patient material, pretreatment methods, and lack of controls preclude any statement concerning effectiveness of radiation therapy for bile duct cancer. A few patients may benefit from the therapy, and use of irradiation techniques as an adjuvant modality is worth continued investigation; however, while internal irradiation for local control of proximal bile duct tumors remains theoretically attractive, there remains little evidence of its efficacy.