[Intraluminal brachytherapy in tumors of the biliary system]

The therapeutic possibilities in tumour of the biliary pathways are rather limited and the survival of patients treated by palliative methods is usually short. The most frequent complication of tumours of the biliary tract is biliary obstruction. A palliative treatment involves surgical derivation of bile the endoscopic or percutaneous route. Irradiation as part of palliative therapy is limited by the relatively low sensitivity of the tumours to radiation and the close contact with various radiosensitive organs. One of the possibilities how to avoid damage of neighbouring organs is local actinotherapy. A suitable approach for introducing a radiation source is a percutaneous drain in the biliary tract. There are several patterns of irradiation programmes, most frequently Irridium 192 is used. The total dose of 30 Gy is divided into six fractions which are administered in the course of 2-3 weeks. Local irradiation is followed by implantation of a metallic self-expanding stent into the stenotic part. The effect of this treatment is diminution of the tumours mass, patency of the branches of the intrahepatic bile ducts obstructed by the tumour and prolongation of the patency of the implanted stents. Complications of local actinotherapy are minimal, the majority of complications is associated with percutaneous drainage. The most suitable indication for this treatment are non-resectable tumours of the upper part of the biliary tract, less suitable are tumours of the gallbladder and ampullomas of the papilla Vateri. In the above indication local actinotherapy is palliative treatment which prolongs survival and improves the patient's comfort.