PTCDを応用したRALS胆管腔内照射法

The Treatment of Advanced Bile Duct Cancer by Percutaneous Bile Drainage with Intraluminal Radiotherapy Using Remote After Loading System (RALS)

要旨　PTCDの手技を応用して内瘻化を図り，このルートを利用したRALS胆管腔内照射療法について述べた．RALSは単独で胆管癌の根治線量が照射可能なため，肝や腸管などの正常臓器への影響や副作用もなく局所制御が可能な利点を有している．14例の胆道癌に対しRALS胆管腔内照射を施行した．切除不能7例では全例生検で癌細胞は消失し，胆管狭窄は改善し，PTCDチューブの抜去が可能であった．そして最長2年6か月をはじめ3例が生存中である．また，非治癒切除後の癌遺残部治療を行った4例でも遺残部胆管の癌はRALSによって消失し，最長2年を経て健在中をはじめ3例が生存中である．根治切除後の再発予防などにも有用である．

　Fourteen patients with advanced biliary tract cancer were treated by intraluminal radiotherapy using Remote After Loading System (RALS). Radiation dose was set at 5 Gy at a depth of 1.5 cm from the energy source. Intraluminal radiotherapy was scheduled once or twice a week, and five times totally.

　Radiation effect was evaluated from improvement of tricture of the bile duct on cholangiography, choledochoscopic findings and biopsy findings as well.

　In 7 patients with unresectable biliary tract cancer, the stricture of the bile duct subsided, and removal of the PTCD tube was not followed by any complication. Three patients are still alive 9 to 30 months after therapy. In 4 patients who underwent palliative resection, the residual cancer were treated with RALS. Postradiation biopsy yielded no cancer tissue and 3 of them are alive without recurrence for 6 to 24 months. In one patient who died 17 months after resection, no local recurrence or jaundice was observed.

　We concluded that RALS is of great value for the treatment of advanced biliary tract cancer.