[Radiotherapy of carcinoma of the biliary system]

One hundred and twenty-two patients with carcinoma of the biliary system were treated with radiotherapy at Jichi Medical School Hospital from 1977 to 1988. Of these, 100 patients were retrospectively analyzed to obtain the outcome of radiation treatment, while 22 patients were excluded from the analysis for recurrence or previous operation when referred. Most of the patients received a total dose of 40 to 60 Gy, with a fraction dose of 1.8 to 3.0 Gy at 3 to 5 settings per week, and 1.3 to 1.5 Gy with interval of 4 to 6 hrs. in the case of accelerated hyperfractionation. It was observed that the over-all median survival time was 5.0 months and that crude survival rates were 24.1% at 1 year and 16.7% at 2 years. From the investigation of prognostic factors by log-rank test, local response after radiation treatment was found to be a factor which influenced the survival rate with a fair statistical significance. As compared to the survival rate of the patients with no response group (NC plus PD), that of good response group (CR plus PR) was significantly higher (p less than 0.005). Of 6 surviving more than 2 years, 5 patients had good responses including 3 complete responses. The survival rate seems to be higher in a group of the short interval between the first symptom and the start of radiotherapy, of no body weight loss, of a short stenosis and of incomplete obstruction, but is not statistically significant. The results suggest that combined modality or altered fractionation regimes should be tried for carcinoma of the biliary system.