Twelve patients with irresectable or recurrent
hilar cholangiocarcinoma were treated with internal biliary drainage followed by intraluminal (iridium-192) and external-beam
radiotherapy. Biliary drainage was accomplished by means of a combined surgical and interventional radiological approach. Initial biliary
decompression was performed surgically by tumour resection, intrahepatic biliary enteric bypass or distal biliary-enteric anastomosis with a temporary
stent. Maintenance of internal biliary drainage and application of intraluminal
radiotherapy were accomplished radiologically with the use of percutaneous dilatation and metallic expandable biliary
endoprostheses. Median survival was 14.5 months; all 12 patients survived for at least 6 months. Early complications during
radiotherapy were minor and included two patients with
cholangitis and one with transient haemobilia.
Jaundice was relieved in ten of 12 patients, while episodes of
cholangitis were seen during long-term follow-up in 11 (median 1.5 episodes per patient). Internal biliary drainage, in conjunction with
radiotherapy, appears to be safe and effective palliation of irresectable or recurrent
hilar cholangiocarcinoma. Patients can maintain a reasonable quality of life with an acceptable incidence of
cholangitis, without the hindrance of external drainage devices.