Skip to main content Accessibility help
×
Home

High-dose-rate brachytherapy planning in palliative management of hilar cholangiocarcinoma: a case study

  • Surega Anbumani (a1), Ramesh S. Bilimagga (a1), Pichandi Anchineyen (a2), Punitha Jayaraman (a1) and Siddanna R. Palled (a3)...

Abstract

Introduction:

Cholangiocarcinoma (CCA) or klatskin’s tumour involves malignant tumours at the liver hilum’s biliary confluence. Incidence of CCA results in unresectable tumours that require appropriate therapy to improve quality of life. The liver is considered as the most frequent site of tumour recurrence. Promising results of long-term survival have been established with computed tomography-guided high-dose-rate brachytherapy.

Materials and methods:

Intraluminal brachytherapy (ILBT) is performed through the percutaneous transhapatic bile duct drain tube (PTBD). The passage of the brachytherapy guide tube through the bile duct is more complex compared with oesophageal/endobronchial application.

Results/discussion:

It results in a recoiled view of the tube in the abdominal region of the computed tomography (CT) scan. Owing to inherent artefacts induced by metal stents in CT scans, intersected view is possible between the ILBT guide tube and the intra-hepatic drain tube. It would mislead the planner to track wrong passage that could result in fatal error.

Conclusion:

In this case study, we contoured the ILBT guide tube by cross-verifying its position with a digitally reconstructed radiograph (DRR) before catheter tracking. Thus, it ensures precise simulation of source dwell positions, thereby avoiding high-dose delivery to nearby vital organs such as intestines, liver hilum and blood vessels.

Copyright

Corresponding author

Correspondence to: Surega Anbumani, LINAC Center, HCG Bangalore Institute of Oncology, 44-45/2, II Cross, RRMR Extension, Off Lalbagh Double Road, Bangalore, Karnataka, India. Tel: +91 812 347 8031; Fax: +91 08040206075; E-mail: suregaanbumani@gmail.com

References

Hide All
1.Blechacz, B R A, Gores, G J. Cholangiocarcinoma. Clin Liver Dis 2008; 12: 131150.
2.Konstantinos, N L, Gores, G J. Cholangiocarcinoma. Gastroenterology 2005; 128: 16551667.
3.Weber, S M, Jarnagin, W R, Klimstra, D. Intrahepatic cholangiocarcinoma: respectability, recurrence pattern, and outcomes. J Am Coll Surg 2001; 193: 384391.
4.Shimada, K, Kishi, Y, Hata, S. Surgical outcomes of the mass forming plus periductal infiltrating types of intraheaptic cholangiocarcinoma: a comparative study with the typical mass forming type of intrahepatic cholangiocarcinoma. World J Surg 2007; 31: 20162022.
5.Kamphues, C, Seehofer, D, Eisele, R M. Recurrent intrahepatic cholangiocarcinoma: single center experience using repeated hepatectomy and radio frequency ablation. J Hepato-Biliary-Pancreat Sci 2010; 17: 509515.
6.Ricke, J, Mohnike, K, Pech, M. Local response and impact on survival after local ablation of liver metastases from colorectal carcinoma by computed tomography guide dose rate brachytherapy. Int J Radiat Oncol Biol Phys 2010; 78: 479485.
7.Mohnike, K, Wieners, G, Schwartz, F. Computed tomography guide high dose rate brachytherapyin hepatocellular carcinoma: safety, efficacy and effect on survival. Int J Radiat Oncol Biol Phys 2010; 78: 172179.
8.Alberts, S R, Gores, G J, Kim, G P. Treatment options for hepatobiliary and pancreatic cancer. Mayo Clin Proc 2007; 82: 628637.
9.Lee, J H, Salem, R, Aslanian, Het al. Endoscopic ultrasound and fine-needle aspiration of unexplained bile duct structures. Am J Gastroenterol 2004; 99: 10691073.
10.Ishii, H, Furuse, J, Nagase, Met al. Relief of jaundice by external beam radiotherapy and intraluminal brachytherapy in patients with extrahepatic cholangiocarcinoma: results without stenting. Hepatogastroenterology 2004; 51: 954957.
11.Barrett, A, Dobbs, J, Morris, Set al. Practical radiotherapy planning, 4th edition. UK: Hodder Arnold, 2009.
12.Comprehensive treatment planning for brachytherapy,Oncentra® Brachy, eBrochure 2011.
13.Milickovic, N B, Baltas, D, Giannouli, S, Lahanas, M, Uzunoglu, N, Zamboglu, N. Autoreconstruction of catheters in CT based Brachytherapy planning. In The use of computers in Radiation therapy. Springer-Verlag: Heidelberg, Berlin; 2000, pp. 502–504.
14.Milickovic, N, Baltas, D, Giannouli, S, Lahanas, M, Zamboglou, N. CT imaging based digitally reconstructed radiographs and their application in brachytherapy. Phys Med Biol 2000; 45 (10): 27822800.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed