Malignant obstructive jaundice - brachytherapy as a tool for palliation.
Sandeep Jain1, Tejinder Kataria, Shyam Singh Bisht
1Medanta Cancer Institute, Medanta - The Medicity.
Journal of Contemporary Brachytherapy
|July 24, 2013
Summary
Intraluminal brachytherapy (ILBT) after biliary drainage (PTCD) and stenting effectively prevents malignant obstructive jaundice stent blockage. This technique shows feasibility and minimal toxicity in patients with malignant obstructive jaundice.
Area of Science:
- Oncology
- Gastroenterology
- Interventional Radiology
Background:
- Malignant obstructive jaundice (MOJ) management often involves biliary stenting via ERCP or PTCD.
- Stent occlusion due to tumor ingrowth/overgrowth is a significant complication, occurring in 30-45% of cases.
Purpose of the Study:
- To evaluate the feasibility and efficacy of intraluminal brachytherapy (ILBT) in preventing stent occlusion in patients with MOJ.
- To assess the role of ILBT in maintaining stent patency after PTCD and stenting.
Main Methods:
- Prospective study of 12 patients with MOJ undergoing PTCD and SEMS placement.
- ILBT delivered 10-14 Gy at 1 cm from the source, using 6 French catheters placed across the malignant stricture.
- Concurrent EBRT and chemotherapy were administered to suitable patients.
Main Results:
- All patients tolerated ILBT well, with minimal acute and late toxicities.
- Stent patency was maintained in 10 out of 12 patients at a mean follow-up of 10.25 months.
- Mean stent patency duration was 9.8 months, with one case of duodenal ulceration.
Conclusions:
- Intraluminal brachytherapy is a feasible and effective adjunct to PTCD and stenting for MOJ.
- ILBT significantly reduces stent occlusion rates and maintains patency with acceptable toxicity profiles.
