IntraoperatIve radIotherapy of extrahepatIc cholangIocarcInoma- a case report

肝外膽管癌之手術中放射線治療病例報告

黃旭年(Hsu-Nien Huang) ； 楊博勝(Po-Sheng Yang) ； 戴宏旗(Hung-Chi Dai) ； 陳裕仁(Yu-Jen Chen)

《放射治療與腫瘤學》 22卷4期 (2015/12) Pp. 315-321

https://doi.org/10.6316/TRO/201522(4)315

摘要

膽管癌是一個存活預後不好的全世界性腫瘤，與全世界10-15%的盛行率相比，台灣2012年癌症報告指出，膽管癌在所有的肝膽癌症中所佔比率約有7.5%。而在其他研究報告中，五年的整體存活率約為20-30%。如果病患能夠開刀的話，主要的治療方式就是手術。對大部份的病人來說，因為複雜的大小血管分佈還有旁邊的重要器官影響，很難達到完全切除，因此，術中或是術後的輔助性治療的角色對癌症治癒就更加重要。在肝外膽管癌的治療文獻中，已使用手術中放射線治療來減少其他更侵入性治療的劑量、減少副作用以增加局部控制及存活率。我們提出一個78歲的男性肝外膽管癌的病患的病例。這個病患在手術中腫瘤切除後使用20 Gy的手術內放射線治療，並且之後並沒有進一步的化學治療和體外放射治療，在追蹤6個月之後並無明顯副作用或腫瘤復發情形。手術中放射線治療，對可以手術並且無局部淋巴轉移的肝外膽管癌病人，也許是安全且合適的治療，同時需長期追蹤晚期副作用和治療結果。

關鍵字

肝外膽管癌 ； 手術切除 ； 手術中放射線治療

並列摘要

Cholangiocarcinoma is a malignant neoplasm with a poor survival worldwide. In the 2012 cancer registration report showed a prevalence rate about 7.5% of all hepatobiliary malignancy in Taiwan whereas it was 10 - 15% in the world. The overall 5-year survival rate is only 20 - 30% in literature. Surgical resection is the mainstay treatment for operable patients. However, complete microscopic (R0) resection is difficult to achieve due to the complicated distribution of vessel network and close surrounding normal organs. Thus, the role of post-operative adjuvant radiotherapy is important but normal tissue radiation tolerance remains a critical issue. By using intraoperative radiaotherapy (IORT), the target lesion could be irradiated with single high-dose fraction while avoiding surrounding tissues. Here, we presented a 78-year-old male with extrahepatic cholangiocarcinoma without regional lymphadenopathy. IORT with 20 Gy via a portable kilovoltage x-ray generator was delivered in operative room after removal of tumor and surrounding tissues. The pathology report showed close surgical margin and no regional lymph node metastasis. No further adjuvant external beam radiotherapy or chemotherapy was given due to none of major risk factor and old age. After 6-month follow up, no evidence of recurrence and complication was noted. We conclude that IORT might be a safe radiotherapy modality for patients with resectable extrahepatic cholangiocarcinoma. The long term follow up for evaluation of late toxicity and treatment outcome is warranted.

並列關鍵字

Extrahepatic cholangiocarcinoma ； Respectability ； Intraoperative radiotherapy