Radiation therapy and photodynamic therapy for biliary tract and ampullary carcinomas View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2008-01

AUTHORS

Hiroya Saito, Tadahiro Takada, Masaru Miyazaki, Shuichi Miyakawa, Kazuhiro Tsukada, Masato Nagino, Satoshi Kondo, Junji Furuse, Toshio Tsuyuguchi, Fumio Kimura, Hideyuki Yoshitomi, Satoshi Nozawa, Masahiro Yoshida, Keita Wada, Hodaka Amano, Fumihiko Miura

ABSTRACT

The purpose of radiation therapy for unresectable biliary tract cancer is to prolong survival or prolong stent patency, and to provide palliation of pain. For unresectable bile duct cancer, there are a number of studies showing that radiation therapy is superior to the best supportive care. Although radiation therapy is used in many institutions, no large randomized controlled trials (RCTs) have been performed to date and the evidence level supporting the superiority of this treatment is low. Because long-term relief of jaundice is difficult without using biliary stenting, a combination of radiation therapy and stent placement is commonly used. As radiation therapy, external-beam radiation therapy is usually performed, but combined use of intraluminal brachytherapy with external beam radiation therapy is more useful for making the treatment more effective. There are many reports demonstrating improved response rates as well as extended survival and time to recurrence achieved by this combination therapy. Despite the low level of the evidence, this combination therapy is performed at many institutions. It is expected that multi-institutional RCTs will be carried out. Unresectable gallbladder cancer with a large focus is usually extensive, and normal organs with high radio sensitivity exist contiguously with it. Therefore, only limited anticancer effects are to be expected from external beam radiation therapy for this type of cancer. The number of reports on ampullary cancer is small and the role of radiation therapy in this cancer has not been established. Combination treatment for ampullary cancer consists of either a single use of intraoperative radiation therapy, postoperative external beam radiation therapy or intraluminal brachytherapy, or a combination of two or three of these therapies. Intraoperative radiation therapy is superior in that it enables precise irradiation to the target site, thereby protecting adjacent highly radiosensitive normal tissues from irradiation. There are reports showing extended survival, although not significant, in groups undergoing intraoperative or postoperative radiation therapy compared with groups without radiation therapy. To date, there are no reports of large RCTs focusing on the significance of radiation therapy as a postoperative adjuvant treatment, so its usefulness as a postoperative adjuvant treatment is not proven. An alternative treatment is photodynamic therapy. There is an RCT demonstrating that, in unresectable bile duct cancer, extended survival and improved quality of life (QOL) have been achieved through a combination of photodynamic therapy and biliary stenting, compared with biliary stenting alone. Results from large RCTs are desired. More... »

PAGES

63-68

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00534-007-1281-y

DOI

http://dx.doi.org/10.1007/s00534-007-1281-y

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1051061180

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/18274845


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18 schema:description The purpose of radiation therapy for unresectable biliary tract cancer is to prolong survival or prolong stent patency, and to provide palliation of pain. For unresectable bile duct cancer, there are a number of studies showing that radiation therapy is superior to the best supportive care. Although radiation therapy is used in many institutions, no large randomized controlled trials (RCTs) have been performed to date and the evidence level supporting the superiority of this treatment is low. Because long-term relief of jaundice is difficult without using biliary stenting, a combination of radiation therapy and stent placement is commonly used. As radiation therapy, external-beam radiation therapy is usually performed, but combined use of intraluminal brachytherapy with external beam radiation therapy is more useful for making the treatment more effective. There are many reports demonstrating improved response rates as well as extended survival and time to recurrence achieved by this combination therapy. Despite the low level of the evidence, this combination therapy is performed at many institutions. It is expected that multi-institutional RCTs will be carried out. Unresectable gallbladder cancer with a large focus is usually extensive, and normal organs with high radio sensitivity exist contiguously with it. Therefore, only limited anticancer effects are to be expected from external beam radiation therapy for this type of cancer. The number of reports on ampullary cancer is small and the role of radiation therapy in this cancer has not been established. Combination treatment for ampullary cancer consists of either a single use of intraoperative radiation therapy, postoperative external beam radiation therapy or intraluminal brachytherapy, or a combination of two or three of these therapies. Intraoperative radiation therapy is superior in that it enables precise irradiation to the target site, thereby protecting adjacent highly radiosensitive normal tissues from irradiation. There are reports showing extended survival, although not significant, in groups undergoing intraoperative or postoperative radiation therapy compared with groups without radiation therapy. To date, there are no reports of large RCTs focusing on the significance of radiation therapy as a postoperative adjuvant treatment, so its usefulness as a postoperative adjuvant treatment is not proven. An alternative treatment is photodynamic therapy. There is an RCT demonstrating that, in unresectable bile duct cancer, extended survival and improved quality of life (QOL) have been achieved through a combination of photodynamic therapy and biliary stenting, compared with biliary stenting alone. Results from large RCTs are desired.
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26 adjuvant treatment
27 alternative treatment
28 ampullary cancer
29 ampullary carcinoma
30 anticancer effects
31 beam radiation therapy
32 best supportive care
33 bile duct cancer
34 biliary stenting
35 biliary tract
36 biliary tract cancer
37 brachytherapy
38 cancer
39 carcinoma
40 care
41 combination
42 combination therapy
43 combination treatment
44 date
45 duct cancer
46 effect
47 evidence
48 evidence level
49 extended survival
50 external beam radiation therapy
51 focus
52 gallbladder cancer
53 group
54 high radio sensitivity
55 improved quality
56 improved response rates
57 institutions
58 intraluminal brachytherapy
59 intraoperative radiation therapy
60 irradiation
61 jaundice
62 large RCTs
63 large focus
64 levels
65 life
66 limited anticancer effects
67 long-term relief
68 low levels
69 multi-institutional RCTs
70 normal organs
71 normal tissues
72 number
73 number of reports
74 number of studies
75 organs
76 pain
77 palliation
78 palliation of pain
79 patency
80 photodynamic therapy
81 placement
82 postoperative adjuvant treatment
83 postoperative external beam radiation therapy
84 postoperative radiation therapy
85 precise irradiation
86 prolong stent patency
87 purpose
88 quality
89 radiation therapy
90 radio sensitivity
91 radiosensitive normal tissues
92 rate
93 recurrence
94 relief
95 report
96 response rate
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101 single use
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103 stent patency
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105 stenting
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