부산대학교 도서관

Cholangiocarcinoma is a malignant neoplasm with a poor survival worldwide. In the 2012 cancer registration report showed a prevalence rate about 7.5% of all hepatobiliary malignancy in Taiwan whereas it was 10 - 15% in the world. The overall 5-year survival rate is only 20 - 30% in literature. Surgical resection is the mainstay treatment for operable patients. However, complete microscopic (R0) resection is difficult to achieve due to the complicated distribution of vessel network and close surrounding normal organs. Thus, the role of post-operative adjuvant radiotherapy is important but normal tissue radiation tolerance remains a critical issue. By using intraoperative radiaotherapy (IORT), the target lesion could be irradiated with single high-dose fraction while avoiding surrounding tissues. Here, we presented a 78-year-old male with extrahepatic cholangiocarcinoma without regional lymphadenopathy. IORT with 20 Gy via a portable kilovoltage x-ray generator was delivered in operative room after removal of tumor and surrounding tissues. The pathology report showed close surgical margin and no regional lymph node metastasis. No further adjuvant external beam radiotherapy or chemotherapy was given due to none of major risk factor and old age. After 6-month follow up, no evidence of recurrence and complication was noted. We conclude that IORT might be a safe radiotherapy modality for patients with resectable extrahepatic cholangiocarcinoma. The long term follow up for evaluation of late toxicity and treatment outcome is warranted.