Summary
Surgical management in the therapy of malignant obstructive jaundice with special regard to cholangiocarcinoma is disappointing in the majority of cases. Even after curative resection has been performed, the local recurrence rate is high and prognosis remains poor. The results of adjuvant and/or additive therapeutic modalities are summarized in this article. The results of chemotherapy or radiotherapy, except for brachytherapy with 192iridium-implants, appear to date to be unsatisfactory. Up to now, intraoperative radiation therapy in combination with curative resection and adjuvant radiation therapy plus 5-fluorouracil seems to be a promising therapeutic modality. Randomized studies are needed to provide clinical evidence for the results with these adjuvant modalities.
Zusammenfassung
Die alleinige chirurgische Therapie des cholangiocellulären Karzinoms ist selbst bei kurativer Resektion nicht mit befriedigenden Ergebnissen verbunden. Mögliche adjuvante und/oder additive Maßnahmen mit dem Ziel der Verbesserung der Prognose werden zusammengefaßt: Die Ergebnisse bei alleiniger Anwendung einer Chemotherapie oder Radiotherapie sind mit Ausnahme der Brachytherapie (Iridium192-Implantate) unbefriedigend. Zum heutigen Zeitpunkt scheint die intraoperative Radiotherapie in Kombination mit einer kurativen Resektion und einer adjuvanten Bestrahlung in Kombination mit 5-Fluorouracil eine Verbesserung der Ergebnisse zu ermöglichen. Die dargestellten Ergebnisse müssen durch randomisierte Studien belegt werden.
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Literatur
Abe M, Takahashi MH (1991) Intraoperative radiation therapy. Pergamon Press, New York Oxford. Beitrag Todoroki
Buskirk SJ, Gunderson LL, Adson MA, Martinez A, May GR, Mcllrath DC, Nagorney DM, Edmundson GK, Bender CE, Martin JK (1984) Analysis of failure following curative irradiation of gallbladder and extrahepatic bile duct carcinoma. Int J Radiation Oncol Biol Phys 10:2013–2023
Chen GX, Wu D, Thao L (1992) Intraoperative radiation therapy for bile duct cancer. Strahlenther Onkol 168:481
Cromheecke M, Vermeij J, Grond AJK, Konings AWT, Oldhoff J, Hoekstra HJ (1993) Tissue tolerance of normal and surgically manipulated canine liver to intraoperative radiation therapy (IORT). Int J Radiation Oncology Biol Phys 27:1141–1146
Ede RJ, Williams SJ, Hatfield ARW, Mcintyre S, Mair G (1989) Endoscopic management of inoperable cholangiocarcinoma using iridium-192. Br J Surg 76:867–869
Fields JN, Emami B (1987) Carcinoma of the extrahepatic biliary system – results of primary and adjuvant radiotherapy. Int J Radiation Oncol Biol Phys 13:331–338
Gunderson LL, Martin JK, Kvols LK, Nagrney DM, Fiek JM, Wieand HS, Martinez A, O’Connel MJ, Earle JD, Mcllrath DC (1987) Intraoperative and external beam irradiation ± 5-FU for locally advanced pancreatic cancer. Int J Radiation Biol Phys 13:319–329
Hansen S, Tempero M, Sorrell M, Shaw B, Donovan J, Kumar P (1993) Chemoradiotherapy followed by orthotopic liver transplantation (OTLT) for proximal cholangiocarcinoma (ChCA): the UNMC experience (Meeting abstract). Proc Annu Meet Am Soc Clin Oncol 12:A695
Hellinger A, Niebel W, Sauerwein W, Eigler FW (1994) Intraoperative radiation therapy in resectable pancreatic cancer – first experiences (Meeting abstract). J Cane Res Clin Oncol in Druck
Johnson DW, Safai C, Goffinet DR (1985) Malignant obstructive jaundice: treatment with external- beam and intracavitary radiotherapy. Int J Radiation Oncol Biol Phys 11:411–416
Kawamura M, Kataoka M, Fujii T, Itoh H, Ishine M, Hamamoto K, Yokoyama S, Takashima S, Satoh M, Inoue K (1992) Electron beam intraoperative radiation therapy (EBIORT) for localized pancreatic carcinoma. Int J Radiation Biol Phys 23:751–757
Mornex F, Ardiet JM, Bret P, Gerard JP (1984) Radiotherapy of high bile duct carcinoma using intracatheter iridium 192 wire. Cancer 54:2069–2073
Rich TA (1991) Protracted (continuous 5–FIuorouracil) infusion with concomitant radiation therapy: indications and results; in: Concomitant continuous infusion chemotherapy and radiation, edited by M. Rotman and C. J. Rosenthal, 181–188
Sauerwein W, Eigler FW, Busch M, Sack H (1989) Intraoperative Strahlentherapie. Med Klin 84:32–39
Schildberg FW, Willich N, Kriimling HJ (1992) Intraoperative Strahlentherapie (IORT) bei malignen Tumoren des Gastrointestinaltrakts. Chirurg 63:251–259
Shiina T, Mikuriya S, Uno T, Toita T, Serizawa S, Itami J, Kawai S, Tani M (1992) Radiotherapy of cholangiocarcinoma: the roles for primary and adjuvant therapies. Cancer Chemother Pharmacol 31:115–118
Stillwagon GB, Order SE, Klein JL, Leichner PK, Leibel SA, Siegelman SS, Fishman EK, Ettinger DS, Haulk T, Kopher K, Brown SM, Finney K (1987) Multimodality treatment of primary nonresectable intrahepatic cholangiocarcinoma with 1311 anti-CEA – a radiation therapy oncology group study. Int J Radiation Oncol Biol Phys 13:687–695
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© 1994 Springer-Verlag Berlin Heidelberg
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Eigler, F.W., Hellinger, A., Sauerwein, W. (1994). Maligner Verschlußikterus: Radio- und/oder Chemotherapie (eine sinnvolle Alternative?). In: Hartel, W. (eds) Die Ambivalenz des Fortschritts — ist weniger mehr?. Deutsche Gesellschaft für Chirurgie, vol 1994. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-79242-7_23
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DOI: https://doi.org/10.1007/978-3-642-79242-7_23
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