Unresectable perihilar cholangiocarcinoma: multimodal palliative treatment.

摘要: Aim: To evaluate the survival of patients with unresectable perihilar cholangiocarcinoma (PHC) treated multimodal palliative approaches. Patients and Methods: thirty-two were enrolled in a protocol including: bilateral biliary drainage; Yridium-192 intraluminal brachytherapy (BT); metal stenting; external-beam radiotherapy (EBRT); systemic chemotherapy (ChT). All underwent BT stenting: this was only treatment for 14 patients, it combined EBRT 11, ChT seven. Mean median survival, complication rates duration hospital stay calculated each group. Results: obtained best (15 months) one year (71.42%) followed by (14 months 63.63%, respectively). total dose 54-60 Gy, or without ChT, led to significantly higher rate than that alone (seven months). Conclusion: EBRT, improves should be considered as suitable alternative surgery cholangiocarcinoma. Cholangiocarcinoma (CCA) is rare tumor bile ducts, high local invasiveness occasional distant metastases (1-3). Worldwide, accounts 3% all primary gastrointestinal malignancies 10% hepatobiliary (4). The most commonly used classification CCA identifies three groups based on location along tree: intrahepatic CCA; (PHC), also called Klatskin tumor; distal (5, 6). type fewer cases, whereas PHC types represent about two-thirds quarter respectively (6). can defined tumors arising above junction cystic duct up including second branches right left ducts has been divided into four Bismuth Malt (1) according extent tumor, system primarily conceived serve guide surgical strategy Due natural rapid progression its low chemosensitivity, remains gold standard treatment. In past decades, minority candidates, but management evolved since original description. fact, large series recently reported literature showed resectability varying from 50 80% (7), 1-, 3-, 5-year overall 74.4%, 47.3%, 34.1%, (7, 8). However, when at time diagnosis metastatic first clinical observation, mortality untreated ranges 70% within 12 (9); therefore, category undergo Given history guided liver complications rather disease, treatments are rational option. Many therapeutic protocols using (intraluminal (BT) external beam (EBRT)) (ChT) decompression have advocated provide resolution jaundice associated elective stenosis (10- 17). date, role these therapies, still