192Ir brachytherapy combined with external beam radiotherapy and biliary stenting for unresectable hilar cholangiocarcinoma.

OBJECTIVE: To evaluate the efficacy and safety of 192Ir brachytherapy combined with external beam radiotherapy (EBRT) and biliary stenting in patients with unresectable hilar cholangiocarcinoma. METHODOLOGY: Clinical data of 62 patients with unresectable hilar cholangiocarcinoma were retrospectively analyzed. All patients received concurrent chemoradiotherapy plus percutaneous biliary stenting. Among them, 32 patients (192Ir group) additionally received 192Ir brachytherapy, and 30 patients (EBRT group) received EBRT alone. Survival outcomes were analyzed using the Kaplan-Meier method. RESULTS: At 3 months after treatment, the objective response rate was 93.8% in the 192Ir group and 70.0% in the EBRT group. Median progression-free survival was 11.2 months vs 8.6 months (P = 0.032), and median overall survival was 14.5 months vs 12.2 months (P = 0.361). Liver function parameters and CA19-9 levels decreased in both groups, with significantly lower levels in the 192Ir group at 3 months. Adverse events were tolerable in both groups. CONCLUSION: 192Ir brachytherapy plus EBRT and biliary stenting may improve short-term tumor response and progression-free survival in unresectable hilar cholangiocarcinoma, with tolerable toxicity.