Room: ePoster Forums
Purpose: To observe the feasibility and short-term efficacy of image-guided adaptive intraluminal high-dose-rate brachytherapy (IGABT) followed by biliary stenting in patients with malignant biliary obstruction.
Methods: A total of 16 patients with malignant biliary obstruction during 2016to2018 were selected.Percutaneous trans-catheter biliary drainage (PTCD) was performed on these patients with GE DSA system,then a Lumen Care applicator with X-ray marker was inserted into PTCD catheter through the section of the obstruction.CT scan was performed to determine the obstructed section and region of the source dwell position.Then the clinical target volume and normal tissues were contoured in MIM software.The prescription of brachy treatment was 14Gy to 90% volume of CTV in two fractions. Before the second irradiation in next day for each patient, the position of catheter with X-ray marker were adjusted by the registration of zero degree digitally reconstructed radiograph imageï¼ˆDRRï¼‰ and guidance in order to ensure that the tumor target could get adequate and accurate irradiation dose.And totally dose 50.4Gy in 28 fractions external IMRT was also given for each case after brachytherapy finished.The metal self-expandable stent was implanted between brachytherapy and external radiotherapy.Other 16 patients who were only given PTCD and 50.4Gy external radiotherapy,were selected as control group for the comparative observation of this therapeutic effect.
Results: All 16 patients with malignant biliary obstruction successfully completed trans-catheter percutaneous trans hepatic biliary stenting and brachytherapy,and serum bilirubin levels decreased to nearly normal level in one month(p= 0.02).No grade III or above adverse reactions occurred. Three months after treatment,the effect of preventing biliary restenosis is better than the control group (93% to 82%, p= 0.01).
Conclusion: Image-guided high-dose-rate brachytherapy can effectively release the malignant obstructive jaundice,prevent biliary restenosis and increase the local control ratio of this disease significantly.IGABT is a safe and effective method that deserves to be applied and promoted.