92 Ir brachytherapy combined with external beam radiation and biliary stenting can improve the local control rate of unresectable hilar cholangiocarcinoma

Abstract

Abstract Objective This study aimed to evaluate the prognostic efficacy and safety of 192Ir brachytherapy combined with external beam radiation in the treatment of unresectable hilar cholangiocarcinoma. Methods In this study, the clinical data of unresectable hilar cholangiocarcinoma patients admitted to our hospital from January 2014 to March 2019 were analyzed retrospectively. The treatment mode was concurrent chemoradiotherapy + biliary stent +/- brachytherapy. Survival was analyzed using the Kaplan–Meier method. Results A total of 62 patients were in covered in this study, including 32 who underwent 192Ir brachytherapy combined with external beam radiation and percutaneous hepatobiliary stenting, which were assigned to the Ir-192 group, and 30 who received external beam radiation and percutaneous hepatobiliary stenting, which were assigned to the EBRT group. After the patients of the Ir-192 group and the EBRT group received 3 months of treatment, the complete remission rates (CRs) reached 15.6% and 6.7%, the partial remission rates (PRs) were 78.1% and 63.3%, and the objective remission rates (ORRs) reached 93.7% and 70%, respectively. Moreover, the median progression-free survival (PFS) was obtained as 11.0 months and 8.5 months, respectively. Besides, the 1-year PFS rates reached 37.5% and 6.3%, and the 2-year PFS rates were 16.7% and 0%, respectively (P = 0.032). In addition, the median overall survival (OS) was 14.5 months and 12.2 months, respectively. Furthermore, the 1-year OS rates were 58.8% and 27.9%, and the 2-year OS rates were 51.6% and 14.7%, respectively (P = 0.361). It is noteworthy that TBIL, DBIL, ALT, AST, and CA19-9 in the Ir-192 group were notably lower than those prior to treatment and 3 months after treatment in the EBRT group. Conclusion 192Ir brachytherapy combined with external beam irradiation and biliary stenting is capable of increasing the local control rate of unresectable hilar cholangiocarcinoma, with reliable prognostic efficacy and tolerable adverse reactions, such that it serves as a feasible and safe treatment method for clinical practice.