The role of radiation therapy in cancer of the extra-hepatic biliary system: An analysis of thirteen patients and a review of the literature of the effectiveness of surgery, chemotherapy and radiotherapy

An analysis of the role of radiotherapy in the management of gallbladder (GB) and extra-hepatic bile duct (EHBD) cancer its based upon thirteen patients irradiated in our hospital and a review of the literature. These patients were treated as part of curative or palliative management in conjunction with surgery, after surgical failure or recurrence, and as the only palliative modality. Doses ranged from 3800 to 7225 rad. Significant palliation was obtained in 92% of the patients; average total bilirubin value decreased from 9.1 mg.% before to 1.7 mg.% after radiotherapy. The mean survival of all patients was 12.7 months after surgery (7.1 in GB, 16.1 in EHBD), and was 7.3 months after initiation of radiotherapy (6.3 in GB, 8.0 in EHBD). Two patients were alive and well with no evidence of disease 12 and 16 months after radiotherapy, and local tumor control was achieved in two. Complications included possible biliary fibrosis. Based upon a critical review of the surgical, chemotherapeutic, and radiotherapeutic literature, it is concluded that present surgical therapy fails because of extensive regional disease in which local recurrences follow various simple and radical surgical maneuvers; palliative surgery often fails. Survival rates have been poor following any therapy at present, although encouraging results are seen with carefully planned megavoltage radiotherapy. A proposal its made to evaluate the role of radiotherapy systematically: as part of curative therapy post-operatively to decrease local recurrences and to increase the length and quality of survival; to treat incisional recurrences; as part of advanced disease management to increase the effectiveness and length of palliation; and in conjunction with chemotherapy to further consolidate therapeutic gains made with radiotherapy alone.