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

Published online by Cambridge University Press:  27 April 2015

Surega Anbumani ,
Ramesh S. Bilimagga ,
Pichandi Anchineyen ,
Punitha Jayaraman  and
Siddanna R. Palled
Surega Anbumani*
Affiliation:
HCG Bangalore Institute of Oncology, Bangalore, Karnataka, India
Ramesh S. Bilimagga
Affiliation:
HCG Bangalore Institute of Oncology, Bangalore, Karnataka, India
Pichandi Anchineyen
Affiliation:
Healthcare Global Enterprises Ltd, Bangalore, Karnataka, India
Punitha Jayaraman
Affiliation:
HCG Bangalore Institute of Oncology, Bangalore, Karnataka, India
Siddanna R. Palled
Affiliation:
Kidwai Memorial Institute of Oncology, Marigowda Road, Bangalore, Karnataka, India
*
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
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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.

Keywords

cholangiocarcinomadigitally reconstructed radiographintraluminal brachytherapy
Type
Case Study
Information
Journal of Radiotherapy in Practice , Volume 14 , Issue 3 , September 2015 , pp. 303 - 306
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Copyright
© Cambridge University Press 2015 

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