192Ir brachytherapy combined with external beam radiation and biliary stenting can improve the local control rate of unresectable hilar cholangiocarcinoma

Objective: To evaluate the prognostic efficacy and safety of 192 Ir brachytherapy combined with external beam radiation in the treatment of unresectable hilar cholangiocarcinoma. Methods The clinical data of patients with unresectable hilar cholangiocarcinoma admitted to Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province from January 2014 to March 2019 were retrospectively analyzed. The treatment mode was concurrent chemoradiotherapy + biliary stent +/- brachytherapy. Survival was analyzed using the Kaplan–Meier method. Results This study included 62 patients; 32 received 192 Ir brachytherapy combined with external beam radiation and percutaneous hepatobiliary stenting as the treatment group, and 30 received external beam radiation and percutaneous hepatobiliary stenting as the control group. After 3 months of treatment, the complete remission rates (CRs) of the treatment group and the control group were 15.6% and 6.7%, respectively, the partial remission rates (PRs) were 78.1% and 63.3%, and the objective remission rates (ORRs) were 93.7% and 70%, respectively. The median progression-free survival (PFS) of the treatment group and the control group was 11.0 months and 8.5 months, respectively. The 1-year PFS rates for the treatment group and the control group were 37.5% and 6.3%, respectively, and the 2-year PFS rates were 16.7% and 0%, respectively. There was a statistically significant difference in the progression-free survival rate between the two groups (P < 0.05). The median overall survival (OS) of the treatment group and the control group was 14.5 months and 12.2 months, respectively. The 1-year OS rates for the treatment group and control group were 58.8% and 27.9%, respectively; the 2-year OS rates were 51.6% and 14.7%, respectively. There was no significant difference in the overall survival rate between the two groups (P > 0.05). TBIL, DBIL, ALT, AST and CA19-9 in the treatment group were significantly lower than those before treatment and 3 months after treatment in the control group, and the difference was statistically significant (P < 0.05). No serious complications, such as bile leakage or biliary tract hemorrhage, occurred. Conclusion 192 Ir brachytherapy combined with external beam radiation and biliary stenting might improve the local control rate of unresectable hilar cholangiocarcinoma, with reliable prognostic efficacy and tolerable adverse reactions, providing a feasible and safe treatment method for clinical practice.