Liver Cancer pp 297-312 | Cite as

Radiation Therapy of Hepatobiliary Tumors

  • Steven A. Leibel
Part of the Developments in Oncology book series (DION, volume 30)

Abstract

External beam radiation therapy has played a limited role in the management of patients with hepatic or extrahepatic biliary carcinoma. The dose of radiation that can be administered to the liver or extrahepatic biliary tract is limited by the radiation tolerance of the normal tissues. The conclusion that radiation therapy is of little benefit to patients with hepatic malignancies has been based on the results of treatment using doses of 2,000–3,000 rad, a dose which is insufficient to locally control solid tumors. However, it has been demonstrated that external beam irradiation can result in significant symptomatic palliation in patients with metastatic disease to the liver. Response rates may be enhanced by combining radiation therapy with chemotherapy [1] or other agents which selectively sensitize the tumor relative to the normal tissue [2]. Ongoing research indicates that improved response rates may be achieved in primary hepatoma by multimodality programs combining radiation therapy, chemotherapy, and radiolabeled antibodies [3].

Keywords

Radium Radioactive Isotope Doxorubicin Luminal Gall 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Friedman M, Cassidy M, Levine M, Phillips TL, Spivack SD, Resser KJ. Combined modality therapy of hepatic metastasis. Cancer 44:906–913, 1979.PubMedCrossRefGoogle Scholar
  2. 2.
    Leibel SA, Order SE, Rominger CJ. Palliation of liver metastases with combined hepatic irradiation and misonidazole. Cancer Clin Trials 4:285–293, 1981.PubMedGoogle Scholar
  3. 3.
    Order SE, Klein JL, Leichner PK, Self S, Leibel SA, Ettinger D. 1–131 radiolabeled antibody (antiferritin) in the treatment of hepatoma—an update. Proc Amer Soc Clin Onc 3:138, 1984.Google Scholar
  4. 4.
    Ingold JA, Reed GB, Kaplan HS, Bagshaw MA. Radiation hepatitis. Am J Roentgenol 93: 200–208, 1965.Google Scholar
  5. 5.
    Rubin P (ed). Radiation biology and radiation pathology syllabus. Chicago: Waverly Press, 1975, pp. 59–75.Google Scholar
  6. 6.
    Ultmann JE, Phillips TL. Treatment of metastatic cancer. In Cancer, Principles and Practices of Oncology, DeVita VT (Jr), Hellman S, Rosenberg SA (eds). Philadelphia: JB Lippincott Co., 1982. pp. 1553–1563.Google Scholar
  7. 7.
    Webber BM, Soderberg CH, Leone LA, Rege VB, Glicksman AS. A combined treatment approach to management of hepatic metastases. Cancer 42:1087–1095, 1978.PubMedCrossRefGoogle Scholar
  8. 8.
    Tefft M, Mitus A, Das L, Vawter GF, Filler RM. Irradiation of the liver in children: review of experience in the acute and chronic phases, and in the intact normal and partially resected. Am J Roentgenol 108:365–385, 1970.Google Scholar
  9. 9.
    Wharton JT, Delclos L, Gallager S, Smith JP. Radiation hepatitis induced by abdominal irradiation with the cobalt 60 moving strip technique. Am J Roentgenol 117:73–80, 1973.Google Scholar
  10. 10.
    Lewin K, Millis RR. Human radiation hepatitis. A morphologic study with emphasis on the late changes. Arch Pathol 96:21–26, 1973.PubMedGoogle Scholar
  11. 11.
    Ogata K, Hizawa K, Yoshida M, Kitamuro T, Akagi G, Kagawa K, Fukuda F. Hepatic injury following irradiation—a morphologic study. Tokushima J Exp Med 9:240–251, 1963.Google Scholar
  12. 12.
    Reed GB Jr, Cox AJ (Jr). The human liver after radiation injury. A form of veno-occlusive disease. Am J Pathol 48:597–607, 1966.PubMedGoogle Scholar
  13. 13.
    Ariel IM, Pack GT. Intra-arterial chemotherapy for cancer metastatic to the liver. Arch Surg 91:851–862, 1965.PubMedGoogle Scholar
  14. 14.
    Foster JH. Survival after liver resection for cancer. Cancer 26:493–502, 1970.PubMedCrossRefGoogle Scholar
  15. 15.
    Rapoport AH, Burleson RL. Survival of patients treated with systemic fluorouracil for hepatic metastases. Surg Gyn Obstet 130(5):773–777, 1970.Google Scholar
  16. 16.
    Ansfield FJ, Ramirez G, SkibbaJL, Bryan GT, Davis HL (Jr), Wirtanen GW. Intrahepatic arterial infusion with 5-fluorouracil. Cancer 28(5):1147–1151, 1971.PubMedCrossRefGoogle Scholar
  17. 17.
    Reed ML, Vaitkevicius VK, Al-Sarraf M, Vaughn CB, Singhakowinta A, Sexon-Porte M, Izbicki R, Baker L, Straatsma GW. The practicality of chronic hepatic artery infusion therapy of primary and metastatic hepatic malignancies: ten-year results of 124 patients in a prospective protocol. Cancer 47:402–409, 1981.PubMedCrossRefGoogle Scholar
  18. 18.
    Almersjo O, Bengmark S, Rudenstam CM, Hafstrom LO, Nilsson LAV. Evaluation of hepatic dearterialization in primary and secondary cancer of the liver. Am J Surg 124:5–9, 1972.PubMedCrossRefGoogle Scholar
  19. 19.
    Phillips RF, Karnofsky DA, Hamilton LD, Nickson JJ. Roentgen therapy of hepatic metastases. Am J Roentgenol 71:826–834, 1954.Google Scholar
  20. 20.
    Turek-Maischeider M, Kazem I. Palliative irradiation for liver metastases. JAMA 232(6):625–628, 1975.PubMedCrossRefGoogle Scholar
  21. 21.
    Prasad B, Lee M-S, Hendrickson FR. Irradiation of hepatic metastases. Int J Rad Onc Biol Phys 2:129–132, 1977.CrossRefGoogle Scholar
  22. 22.
    Sherman DM, Weichselbaum R, Order SE, Cloud L, Trey C, Piro AJ. Palliation of hepatic metastasis. Cancer 41:2013–2017, 1978.PubMedCrossRefGoogle Scholar
  23. 23.
    Borgelt BB, Gelber R, Brady LW, Griffin T, Hendrickson FR. The palliation of hepatic metastases: results of the radiation therapy oncology group pilot study. Int J Rad Onc Biol Phys 7:587–592, 1981.CrossRefGoogle Scholar
  24. 24.
    Pajak TF, Davis DR, Leibel SA, Russell AH. Selection of an optimal population for future liver metastases studies. Proc Amer Soc Clin Onc 25 (abstract 788), 1984.Google Scholar
  25. 25.
    Leibel SA, Pajak TF. Unpublished data.Google Scholar
  26. 26.
    Grady ED. Internal radiation therapy of hepatic cancer. Dis Col & Rect 22(6):371–375, 1979.CrossRefGoogle Scholar
  27. 27.
    Ariel IM, Padula G. Treatment of symptomatic metastatic cancer to the liver from primary colon and rectal cancer by the intra-arterial administration of chemotherapy and radioactive isotopes. Prog Clin Cancer 7:247–254, 1978.PubMedGoogle Scholar
  28. 28.
    Mantravadi RVP, Spigos DG, Tan WS, Felix EL. Intraarterial Yttrium 90 in the treatment of hepatic malignancy. Radiology 142:783–786, 1982.PubMedGoogle Scholar
  29. 29.
    Order SE, Leibel SA. Radiolabeled antibodies in the treatment of primary liver cancer. Applied Radiology 13:67–73, 1984.Google Scholar
  30. 30.
    Friedman MA. Primary hepatocellular cancer—present results and future prospects. Int J Rad Onc Biol Phys 9:1841–1850, 1983.Google Scholar
  31. 31.
    Phillips R, Murikami K. Primary neoplasms of the liver. Results of radiation therapy. Cancer 4(13):714–720, 1960.CrossRefGoogle Scholar
  32. 32.
    Leibel SA. Radioimmunotherapy (ch. 27). In Modern Radiation Oncology, Gilbert HA (ed). Philadelphia: JB Lippincott, 1983, pp. 581–606.Google Scholar
  33. 33.
    Order SE, Klein JL, Leichner PK, Wharam MD, Chambers J, Kopher K, Ettinger DS, Siegelman S. Radiolabelled antibodies in the treatment of primary liver malignancies. In Gastrointestinal Cancer, Levin B, Riddell R (eds). New York: Elsevier North-Holland, 1984, pp. 222–232.Google Scholar
  34. 34.
    Kopelson G, Harisiadis L, Tretter P, Chang CH. 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. Int J Rad Onc Biol Phys 2:883–894, 1977.CrossRefGoogle Scholar
  35. 35.
    Kopelson G, Galdabini J, Warshaw AL, Gunderson LL. Patterns of failure after curative surgery for extra-hepatic biliary tract carcinoma: implications for adjuvant therapy. Int J Rad Onc Biol Phys 7:413–417, 1981.CrossRefGoogle Scholar
  36. 36.
    Macdonald JS, Gunderson LL, Alson MA. Cancer of the hepatobiliary system. In Cancer, Principles and Practices of Oncology, DeVita VT (Jr), Hellman S, Rosenberg SA (eds). Philadelphia: JB Lippincott Co., 1982, pp. 590–615.Google Scholar
  37. 37.
    Vaittinen E. Carcinoma of the gallbladder: a study of 390 cases diagnosed in Finland 1953–1967. Ann Chir Gyn Fenn (Suppl) 168:1–81, 1970.Google Scholar
  38. 38.
    Warren KW, Mountain JC, Lloyd-Jones W. Malignant tumours of the bile-ducts. Br J Surg 59(7):501–505, 1972.PubMedCrossRefGoogle Scholar
  39. 39.
    Braasch JW, Warren KW, Kune GA. Malignant neoplasms of the bile ducts. Surg Clin N Amer 47(3):627–638, 1967.PubMedGoogle Scholar
  40. 40.
    Green N, Mikkelsen WP, Kernen JA. Cancer of the common hepatic bile ducts—palliative radiotherapy. Radiology 109:687–689, 1973.PubMedGoogle Scholar
  41. 41.
    Hishikawa Y, Shimada T, Miura T, Imajyo Y. Radiation therapy of carcinoma of the extrahepatic bile ducts. Radiology 146:787–789, 1983.PubMedGoogle Scholar
  42. 42.
    Smoron GL. Radiation therapy of carcinoma of gallbladder and biliary tract. Cancer 40: 1422–1424, 1977.PubMedCrossRefGoogle Scholar
  43. 43.
    Hanna SS, Rider WD. Carcinoma of the gallbladder or extrahepatic bile ducts: The role of radiotherapy. CMA J 118:59–61, 1978.Google Scholar
  44. 44.
    Black K, Lianna SS, Langer B, Jirsch DW, Rider WD. Management of carcinoma of the extrahepatic bile ducts. Can J Surg 21(6):542–545, 1978.PubMedGoogle Scholar
  45. 45.
    Pilepich MV, Lambert PM. Radiotherapy of carcinomas of the extrahepatic biliary system. Radiology 127:767–770, 1978.PubMedGoogle Scholar
  46. 46.
    Kopelson G, Chu AM, Doucette JA, Gunderson LL. Extrahepatic biliary tract metastases from breast cancer. Int J Rad Onc Biol Phys 6:497–504, 1980.CrossRefGoogle Scholar
  47. 47.
    Hudgins PT, Meoz RT. Radiation therapy for obstructive jaundice secondary to tumor malignancy. Int J Rad Onc Biol Phys 1:1195–1198, 1976.CrossRefGoogle Scholar
  48. 48.
    Meyer JE, Messer RJ, Patel VC. Diagnosis and treatment of obstructive jaundice secondary to liver metastases. Cancer 41:773–775, 1978.PubMedCrossRefGoogle Scholar
  49. 49.
    McLean GK, Ring EJ, Freiman DB. Therapeutic alternatives in the treatment of intrahepatic biliary obstruction. Radiology 145:289–295, 1982.PubMedGoogle Scholar
  50. 50.
    Conroy RM, Shahbazian AA, Edwards KC, Moran EM, Swingle KF, Lewis GJ, Pribram HFW. A new method for treating carcinomatous biliary obstruction with intracatheter radium. Cancer 49:1321–1327, 1982.PubMedCrossRefGoogle Scholar
  51. 51.
    Fletcher MS, Dawson JL, Wheeler PG, Brinkley D, Nunnerley H, Williams R. Treatment of high bileduct carcinoma by internal radiotherapy with iridium-192 wire. Lancet July 25: 172–174, 1981.CrossRefGoogle Scholar
  52. 52.
    Herskovic A, Heaston D, Engler MJ, Fishburn RI, Jones RS, Noell KT. Irradiation of biliary carcinoma. Radiology 139:219–222, 1981.PubMedGoogle Scholar
  53. 53.
    Chitwood WR (Jr), Meyers WC, Heaston DK, Herskovic AM, McLeod ME, Jones RS. Diagnosis and treatment of primary extrahepatic bile duct tumors. Am J Surg 143:99–106, 1982.PubMedCrossRefGoogle Scholar
  54. 54.
    Prempree T, Cox EF, Sewchand W, Tang C-K. Cholangiocarcinoma. Act Radiologica Onc 22:353–359, 1983.CrossRefGoogle Scholar
  55. 55.
    Buskirk SJ, Gunderson LL, Adson MA, Martinez A, May GR, McIlrath DC, Nagorney DM, Edmundson GK, Bender CE, Martin JK (Jr). Analysis of failure following curative irradiation of gallbladder and extrahepatic bile duct carcinoma. Int J Rad Onc Biol Phys (in press).Google Scholar
  56. 56.
    Todoroki T, Iwasaki Y, Okamura T, Hagoshi K, Asakura H, Nakano M, Inada T, Tsunemoto H, Umegaki Y, Nishimura A, Nakano M, Sato H. Intraoperative radiotherapy for advanced carcinoma of the biliary system. Cancer 46:2179, 1980.PubMedCrossRefGoogle Scholar
  57. 57.
    Heaston DK, Herskovic AM, Engler MJ, Noell KT. Radical radiotherapy for bile duct carcinoma. J Endocurietherapy (in press).Google Scholar
  58. 58.
    Gunderson LL, Meyer JE, Sheedy II PF, Munzenrider JE. Radiation oncology (ch. 93). In Alimentary Tract Radiotherapy, Margolis AR, Burhenne HS (eds). Philadelphia: CV Mosby Co., 1979, pp. 2409–2446.Google Scholar
  59. 59.
    Sindelar WF, Tepper J, Travis EL. Tolerance of bile duct to intraoperative irradiation. Surgery 92(3):533–540, 1982.PubMedGoogle Scholar

Copyright information

© Martinus Nijhoff Publishing, Boston/Dordrecht/Lancaster 1985

Authors and Affiliations

  • Steven A. Leibel

There are no affiliations available

Personalised recommendations