The prognosis of
bile duct cancer is still poor. Curative surgical
therapy is possible in only 10%-20% of cases. Palliative effects of
chemotherapy and radiation are small. Newer palliative techniques like
iridium 192 wire radiation or hepatic artery infusion of chemotherapeutic agents seem to be more effective. Another new form of palliative local
chemotherapy, intrabiliary application of
5-fluorouracil, is described. A 67-year-old woman with an
adenocarcinoma of the left and common hepatic ducts received symptomatic
therapy by an external biliary drainage for 20 months. In the following 3 weeks the amount of drained bile diminished and finally stopped, while
icterus occurred.
Catheter cholangiography showed a right
catheter position, the known obstruction of the common hepatic duct and the left bile duct, and a diffuse right-sided peripheral bile duct occlusion, regarded as multifocal
tumor spreading. Intraductal application of
5-fluorouracil via the PTCD tube, 125-375 mg twice a week, effected a rising bile secretion after a few days, to a final volume of 1,000 ml/day. An X-ray control 34 days after start of the
therapy showed a nearly complete reopening of the formerly occluded peripheral bile duct system and a filiform reopening of the common hepatic duct with sufficient flowing off into the common bile duct and the duodenum. Certain side effects of this
therapy were not noticed. After successful reopening of malignant bile tract occlusion, other palliative therapeutic techniques like internal bile drainage or
iridium 192 wire radiation can be applied.