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Interstitial Brachytherapy for Solitary Metastatic Lesions of Lung and Liver
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Abstracts / Brachytherapy 10 (2011) S14eS101
[i] NUREG-1272, Analysis and Evaluation of Operational Data, U.S. Nuclear Regulatory Commission, Washington D.C.; 1992.
Conclusions: Percutaneous 125I seed implantation for recurrent soft tissue malignancies under CT or ultrasound guidance is safe and minimally invasive, and is associated with high efficacy and low morbidity.
PD76 Brachytherapy in Anal Canal Cancers With Newly Made Surface Applicator: An Indian Experience Pooja Nandwani Patel, MD, Rakesh Vyas, MD, Maitrik Mehta, MD. Radiation Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India. Purpose: Our aim was to evaluate the role of this newly made surface applicator for intraluminal brachytherapy following chemo-radiotherapy in carcinoma of anal canal patients. Materials and Methods: In our study we included 40 patients with squamous cell carcinoma of anal canal treated with combined chemoradiotherapy. All patients were given Mitomycin C þ 5 Fluorouracil on day 1 to 5, followed by external beam radiotherapy from day 6. The dose of external beam radiotherapy was 50 Gy in 25 #. In our study we have done brachytherapy with surface applicator designed by us. The applicator was fabricated from a clear cast acrylic cylindrical rod of 10 cms length and 2 / 2.5 cm in diameter. The brachytherapy was given 7 e 10 days after external radiotherapy. Total of 15 Gy were given in 2 # at 1-week interval, on Microselectron HDR with Iridium 192. The brachytherapy was given selectively to the involved wall of anal canal. Results: The treatment was well tolerated. Followup of these patients ranged from 12 to 45 months. The 3 year loco regional control (LRC), disease free survival (DFS) & overall survival (OS) were 72%, 81% & 86%, respectively. Only 4 patients developed bleeding per rectum and were managed conservatively. Conclusions: Brachytherapy with newly designed surface applicator is simple and inexpensive. With this new applicator we can selectively treat wall of anal canal having the disease and sparing rest of the normal wall. It is a good alternative to interstitial brachytherapy in superficial cancers of the anal canal.
PD77 Image-Guided Percutaneous 125I Seed Implantation as a Salvage Treatment for Recurrent Soft Tissue Sarcomas After Surgery and Radiotherapy Yuliang Jiang, MD1, Jinna Li, MD1, Junjie Wang, MD, PhD1, Na Meng, MD1, Ang Qu, MD1, Weiqiang Ran, MD2, Huishu Yuan, MD3, Ruijie Yang, MD, PhD1. 1Radiation Oncology, Peking University 3rd Hospital, Beijing, China; 2Ultrasound, Peking University 3rd Hospital, Beijing, China; 3 Radiation Oncology, Peking University 3rd Hospital, Beijing, China. Purpose: The purpose of this study was to evaluate the safety and efficacy of percutaneous 125I seed implantation using CT or ultrasound guidance in the treatment of recurrent soft tissue malignancies after surgery and radiotherapy. Materials and Methods: From February 2002 to September 2009, we treated 18 patients with recurrent soft tissue sarcomas under ultrasound or CT guidance. All 18 patients underwent evaluatation of implantation quality with CT scans. The actuarial median number of 125I seeds implanted was 35 (range, 6 to 129), and the actuarial D90 of the implanted 125I seeds ranged from 107.9 to 204.4 Gy (median, 147.1 Gy). The activity of the seeds ranged from 0.4 mCi to 0.8 mCi (median, 0.7 mCi). Followup times ranged from 4 to 78 months (median, 20 months). Results: The median local control was 41 months (95% CI, 15.9e66.1 months). The 1-, 2-, 3-, 4, and 5-year local controls were 78.8%, 78.8%, 78.8%, 26.3%, and 0%, respectively. The median survival was 32 months (95% CI, 16e48 months). The actuarial 1-, 2-, 3-, 4-and 5-year survivals were 76.6%, 61.3%, 39.4%, 39.4% and 39.4%, respectively. Seven patients (38.9%) experienced recurrence after seed implantation. Six patients (33.3%) died of distant metastases and one died of stroke. Two patients developed ulceration, 1 case caused by recurrence and another by a reaction of the skin to radiation.
CT scan show the seed distribution in tumor after seed implant.
PD78 Radioactive 125I Seed Implantation for Treatment Multiple Bone Metastases by Co-axial Needle Technique in CT Guided Xuequan Huang, MD, PhD, Jiuquan Zhang, MD. Radiology Department, Southwest Hospital, Affiliated to the Third Military Medical University, Gao Tan Yan, Sha Ping Ba, Chongqing City, China. Purpose: To investigate the clinical value of CT guided radioactive seed 125I implantation in treating bone metastasis. Materials and Methods: 41 Patients(male 23, female 18, median age 49.8) with multiple bone metastasis performed CT-guided radioactive seed 125I implantation were recruited in this investigation. Among them, 9 with adenocarcinoma of lung, 6 with squamous cell carcinoma of lung, 4 renal clear-cell carcinoma, 5 with hepatocellular carcinoma, colon carcinoma respectively, 4 carcinoma of prostate respectively, 3 with breast carcinoma, 2 with pancreatic cancer, 1 with osteosarcoma, leiomyosarcoma, malignant schwannoma, respectively. All patients totally had 167 metastatic lesions, every one of them has one or more painful sites. Under CT guidance, 125I seeds were implanted into bone metastasis by co-axial needle technique according to TPS, the minimum peripheral doses (mPD) was110 e 160 Gy. The visual analogue scale (VAS)were used to assess bone pain and the imaging of lesion areas to assess the treatment response. Results: In 41 cases, complete pain relief was seen in 27 cases, partial relief in 9 cases and no change in 5 cases with an effective rate of 87.8%. After operation 2 months, 158/167 (94.6%) lesions were no change(NC) and local control(LC), 9/167 (5.4%) lesions progress (PD). Followup in every 3 months until patient died or missing followup. Local control rates for 1 year, 2 years and 3 years were 90.4%, 74.3%, 59.9%. Conclusions: CT guided radioactive seed 125I implantation procedure has good clinical effects in treating bone metastasis with minimal invasive and few complications, it may be appropriate for treating multiple bone metastasis.
PD79 Interstitial Brachytherapy for Solitary Metastatic Lesions of Lung and Liver Ajeet K. Gandhi, MBBS, Daynand N. Sharma, MD, Goura K. Rath, MD. Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India. Purpose: To study the feasibility of interstitial brachytherapy (IBT) in patients with solitary metastatic lesions of lung and liver, not suitable for surgery.
Abstracts / Brachytherapy 10 (2011) S14eS101 Materials and Methods: Twelve patients with solitary metastatic lesions in lung (9 patients) or liver (3 patients), were enrolled in this study. The procedure of IBT was carried out in CT scan room under local anesthesia. A single stainless steel blind end needle for lesions up to 4 cm and two needles for lesions up to 6 cm in diameter were used. The needle was inserted percutaneously through the intercostal space into the center of lesion under the CT guidance. A single dose of 20 Gy with high-dose-rate (HDR) brachytherapy was prescribed at the periphery of lesion. The treatment was delivered on remote afterloading HDR brachytherapy unit in adjacent room and the needle was removed immediately after treatment. Results: There were 8 males and 4 females with a median age of 52 years. The lesion size raged from 3.0e5.5 cm (median 4.0 cm). The average time taken in IBT procedure was 50 minutes. No patient had acute severe procedure related complication (hemo/pneumothorax or hemoptysis) during perioperative period. CT scan at one month revealed complete regression (CR) of the lesion in 1 patient; and more than 50% regression (partial regression, PR) in 5 patients and minimal response in 2 patients. At 6 month followup, 8 patients had complete ablation of the lesion. One patient developed jaundice 3 months after the procedure. Conclusions: IBT with HDR is safe and feasible in the treatment of solitary metastatic lesions of lung and liver.
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Results: The followup ranged from 3 to 44 months (median, 11 months). The median local control was 24 months (95% CI, 10.2e37.8). The 1 -, 2 e and 3 e year local controls were 73.3%, 27.5% and 27.5%, respectively, whereas the 1 -, 2 e and 3 e year survival rates were 53.0%, 18.2% and 18.2%, respectively, and the median survival was 13 months (95% CI, 6.6e19.4). 26.3% of patients (5/19) died of local recurrence and 21.1% of patients (4/19) died of metastases. Conclusions: 125I seed implantation is feasible and safe as a salvage treatment for patients with recurrent head and neck cancers.
PD80 Radioactivity Seeds Interstitial Brachtherapy Treating Malignant Salivary Gland Tumors Jie Zhang, Dr, Lei Zhen, Dr, Mingwei Huang, Dr, Shuming Liu, Dr, Guangyan Yu, Dr, Jianguo Zhang, Bachelor. Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China. Purpose: To detect the efficacy of radioactive seeds implanting treating malignant salivary gland tumors. Materials and Methods: Forty-three patients with malignant salivary gland tumors of head neck were treated at Peking University stomatologic hospital with radioactivity seeds brachytherapy between the years 2001 and 2008. These patients were implanted 125I with dose of 120e160 Gy. The treatment response, local control rate and survive rate were evaluated and the adverse events were observed. Results: Tumors of twenty-nine patients were got complete remission(CR), tumors of seven patients were partial remission(PR), the response rate was 83.7%. The patients were followed up 8e48 months (median 21 months), local control rate was 79%, total survival rate was 76.7%. No serious side radiotherapeutic effect was observed. Conclusions: Radioactivity seeds interstitial brachytherapy is an effective form of treatment for patients with unresectable malignant salivary gland tumors.
PD81 Image-Guided 125I Permanent Implantation as Salvage Therapy for Recurrent Head and Neck Carcinoma After Surgery and Radiotherapy Yuliang Jiang, MD1, Junjie Wang, MD, PhD1, Ping Jiang, MD1, Weiqiang Ran, MD2, Huishu Yuan, MD3, Ruijie Yang, MD, PhD1. 1Radiation Oncology, Peking University, Beijing, China; 2Ultrasound, Peking University, Beijing, Beijing, China; 3Radiology, Peking University, Beijing, China. Purpose: The management of recurrent head and neck cancer pose a challenging problem. We studied the efficacy and safety of 125I seed implantation for recurrent head and neck carcinoma after syrgery and radiotherapy. Materials and Methods: Between Jan 2004 and Dec 2009, 19 patients with recurrent head and neck carcinoma after surgery and radiotherapy underwent 125I seed implantation under CT or ultrasound guidance. The post-plan showed that the actuarial D90 of 125I seeds ranged from 90 to 160 Gy (median, 131 Gy).
The isodose curve distribution after seed implant.
PD82 Prolonged Stent Patency With Endoscopic Assisted HDR-192IR-ILBT in the Management of Malignant Biliary Obstruction Gian Carlo Mattiucci, Medical School1, Carla Germana Rinaldi, Medical School1, Luca Tagliaferri, Medical School1, Joao Ausem, Medical School1, Mario Balducci, Medical School1, Berardino De Bari, Medical School1, Daniela Smaniotto, Medical School1, Andrea Tringali, Medical School2, Massimiliano Mutignani, Medical School2, Guido Costamagna, Medical School2, Numa Cellini, Medical School1. 1Radiation Oncology, Catholic University of the Sacred Heart, Rome, Italy; 2Digestive Endoscopy, Catholic University of the Sacred Heart, Rome, Italy. Purpose: To evaluate the feasibility and safety of endoscopic assisted highdose-rate intraluminal brachytherapy (HDR-192Ir-ILBT) in the palliative treatment of extrahepatic biliary tract cancer with a focus on acute and late toxicity, stent patency and overall survival. Materials and Methods: Elegibility criteria included patients with non metastatic extrahepatic biliary cancer, age more than 79 years or younger patients unsuitable for surgical resection or radiochemotherapy for comorbidities or ECOG performance score more than 2. Patients were treated with implantation of metal stents placed during endoscopic retrograde cholangiopancreatography followed by HDR-192Ir-ILBT. Patients were evaluated for acute and late toxicity, stent patency and survival. Biliary patency was monitored with serial bilirubin levels, alkaline phosphatase levels, and/or cholangiography (if clinical findings suggested stent occlusion). Stents were considered patent in the absence of worsening jaundice with or without cholangitis. Survival rates were calculated from the time of placement of the metallic stent. Results: From May 2004 to April 2010, biliary drainage using selfexpandable metal stents was performed in 22 patients (10 females, 12 males; mean age 79,5; 11 common bile duct tumors,4 Klatskin I tumors, 3 Klatskin II and 4 Klatskin III) before HDR-192Ir-ILBT. In 3 patients we used 3 stents, in 5 and 14 patients we used respectively 2 and 1 stent. In all cases a complete drainage of the biliary tract was reached. After this procedure one patient experienced acute pancreatitis (one common
Abstracts / Brachytherapy 10 (2011) S14eS101
[i] NUREG-1272, Analysis and Evaluation of Operational Data, U.S. Nuclear Regulatory Commission, Washington D.C.; 1992.
Conclusions: Percutaneous 125I seed implantation for recurrent soft tissue malignancies under CT or ultrasound guidance is safe and minimally invasive, and is associated with high efficacy and low morbidity.
PD76 Brachytherapy in Anal Canal Cancers With Newly Made Surface Applicator: An Indian Experience Pooja Nandwani Patel, MD, Rakesh Vyas, MD, Maitrik Mehta, MD. Radiation Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India. Purpose: Our aim was to evaluate the role of this newly made surface applicator for intraluminal brachytherapy following chemo-radiotherapy in carcinoma of anal canal patients. Materials and Methods: In our study we included 40 patients with squamous cell carcinoma of anal canal treated with combined chemoradiotherapy. All patients were given Mitomycin C þ 5 Fluorouracil on day 1 to 5, followed by external beam radiotherapy from day 6. The dose of external beam radiotherapy was 50 Gy in 25 #. In our study we have done brachytherapy with surface applicator designed by us. The applicator was fabricated from a clear cast acrylic cylindrical rod of 10 cms length and 2 / 2.5 cm in diameter. The brachytherapy was given 7 e 10 days after external radiotherapy. Total of 15 Gy were given in 2 # at 1-week interval, on Microselectron HDR with Iridium 192. The brachytherapy was given selectively to the involved wall of anal canal. Results: The treatment was well tolerated. Followup of these patients ranged from 12 to 45 months. The 3 year loco regional control (LRC), disease free survival (DFS) & overall survival (OS) were 72%, 81% & 86%, respectively. Only 4 patients developed bleeding per rectum and were managed conservatively. Conclusions: Brachytherapy with newly designed surface applicator is simple and inexpensive. With this new applicator we can selectively treat wall of anal canal having the disease and sparing rest of the normal wall. It is a good alternative to interstitial brachytherapy in superficial cancers of the anal canal.
PD77 Image-Guided Percutaneous 125I Seed Implantation as a Salvage Treatment for Recurrent Soft Tissue Sarcomas After Surgery and Radiotherapy Yuliang Jiang, MD1, Jinna Li, MD1, Junjie Wang, MD, PhD1, Na Meng, MD1, Ang Qu, MD1, Weiqiang Ran, MD2, Huishu Yuan, MD3, Ruijie Yang, MD, PhD1. 1Radiation Oncology, Peking University 3rd Hospital, Beijing, China; 2Ultrasound, Peking University 3rd Hospital, Beijing, China; 3 Radiation Oncology, Peking University 3rd Hospital, Beijing, China. Purpose: The purpose of this study was to evaluate the safety and efficacy of percutaneous 125I seed implantation using CT or ultrasound guidance in the treatment of recurrent soft tissue malignancies after surgery and radiotherapy. Materials and Methods: From February 2002 to September 2009, we treated 18 patients with recurrent soft tissue sarcomas under ultrasound or CT guidance. All 18 patients underwent evaluatation of implantation quality with CT scans. The actuarial median number of 125I seeds implanted was 35 (range, 6 to 129), and the actuarial D90 of the implanted 125I seeds ranged from 107.9 to 204.4 Gy (median, 147.1 Gy). The activity of the seeds ranged from 0.4 mCi to 0.8 mCi (median, 0.7 mCi). Followup times ranged from 4 to 78 months (median, 20 months). Results: The median local control was 41 months (95% CI, 15.9e66.1 months). The 1-, 2-, 3-, 4, and 5-year local controls were 78.8%, 78.8%, 78.8%, 26.3%, and 0%, respectively. The median survival was 32 months (95% CI, 16e48 months). The actuarial 1-, 2-, 3-, 4-and 5-year survivals were 76.6%, 61.3%, 39.4%, 39.4% and 39.4%, respectively. Seven patients (38.9%) experienced recurrence after seed implantation. Six patients (33.3%) died of distant metastases and one died of stroke. Two patients developed ulceration, 1 case caused by recurrence and another by a reaction of the skin to radiation.
CT scan show the seed distribution in tumor after seed implant.
PD78 Radioactive 125I Seed Implantation for Treatment Multiple Bone Metastases by Co-axial Needle Technique in CT Guided Xuequan Huang, MD, PhD, Jiuquan Zhang, MD. Radiology Department, Southwest Hospital, Affiliated to the Third Military Medical University, Gao Tan Yan, Sha Ping Ba, Chongqing City, China. Purpose: To investigate the clinical value of CT guided radioactive seed 125I implantation in treating bone metastasis. Materials and Methods: 41 Patients(male 23, female 18, median age 49.8) with multiple bone metastasis performed CT-guided radioactive seed 125I implantation were recruited in this investigation. Among them, 9 with adenocarcinoma of lung, 6 with squamous cell carcinoma of lung, 4 renal clear-cell carcinoma, 5 with hepatocellular carcinoma, colon carcinoma respectively, 4 carcinoma of prostate respectively, 3 with breast carcinoma, 2 with pancreatic cancer, 1 with osteosarcoma, leiomyosarcoma, malignant schwannoma, respectively. All patients totally had 167 metastatic lesions, every one of them has one or more painful sites. Under CT guidance, 125I seeds were implanted into bone metastasis by co-axial needle technique according to TPS, the minimum peripheral doses (mPD) was110 e 160 Gy. The visual analogue scale (VAS)were used to assess bone pain and the imaging of lesion areas to assess the treatment response. Results: In 41 cases, complete pain relief was seen in 27 cases, partial relief in 9 cases and no change in 5 cases with an effective rate of 87.8%. After operation 2 months, 158/167 (94.6%) lesions were no change(NC) and local control(LC), 9/167 (5.4%) lesions progress (PD). Followup in every 3 months until patient died or missing followup. Local control rates for 1 year, 2 years and 3 years were 90.4%, 74.3%, 59.9%. Conclusions: CT guided radioactive seed 125I implantation procedure has good clinical effects in treating bone metastasis with minimal invasive and few complications, it may be appropriate for treating multiple bone metastasis.
PD79 Interstitial Brachytherapy for Solitary Metastatic Lesions of Lung and Liver Ajeet K. Gandhi, MBBS, Daynand N. Sharma, MD, Goura K. Rath, MD. Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India. Purpose: To study the feasibility of interstitial brachytherapy (IBT) in patients with solitary metastatic lesions of lung and liver, not suitable for surgery.
Abstracts / Brachytherapy 10 (2011) S14eS101 Materials and Methods: Twelve patients with solitary metastatic lesions in lung (9 patients) or liver (3 patients), were enrolled in this study. The procedure of IBT was carried out in CT scan room under local anesthesia. A single stainless steel blind end needle for lesions up to 4 cm and two needles for lesions up to 6 cm in diameter were used. The needle was inserted percutaneously through the intercostal space into the center of lesion under the CT guidance. A single dose of 20 Gy with high-dose-rate (HDR) brachytherapy was prescribed at the periphery of lesion. The treatment was delivered on remote afterloading HDR brachytherapy unit in adjacent room and the needle was removed immediately after treatment. Results: There were 8 males and 4 females with a median age of 52 years. The lesion size raged from 3.0e5.5 cm (median 4.0 cm). The average time taken in IBT procedure was 50 minutes. No patient had acute severe procedure related complication (hemo/pneumothorax or hemoptysis) during perioperative period. CT scan at one month revealed complete regression (CR) of the lesion in 1 patient; and more than 50% regression (partial regression, PR) in 5 patients and minimal response in 2 patients. At 6 month followup, 8 patients had complete ablation of the lesion. One patient developed jaundice 3 months after the procedure. Conclusions: IBT with HDR is safe and feasible in the treatment of solitary metastatic lesions of lung and liver.
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Results: The followup ranged from 3 to 44 months (median, 11 months). The median local control was 24 months (95% CI, 10.2e37.8). The 1 -, 2 e and 3 e year local controls were 73.3%, 27.5% and 27.5%, respectively, whereas the 1 -, 2 e and 3 e year survival rates were 53.0%, 18.2% and 18.2%, respectively, and the median survival was 13 months (95% CI, 6.6e19.4). 26.3% of patients (5/19) died of local recurrence and 21.1% of patients (4/19) died of metastases. Conclusions: 125I seed implantation is feasible and safe as a salvage treatment for patients with recurrent head and neck cancers.
PD80 Radioactivity Seeds Interstitial Brachtherapy Treating Malignant Salivary Gland Tumors Jie Zhang, Dr, Lei Zhen, Dr, Mingwei Huang, Dr, Shuming Liu, Dr, Guangyan Yu, Dr, Jianguo Zhang, Bachelor. Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China. Purpose: To detect the efficacy of radioactive seeds implanting treating malignant salivary gland tumors. Materials and Methods: Forty-three patients with malignant salivary gland tumors of head neck were treated at Peking University stomatologic hospital with radioactivity seeds brachytherapy between the years 2001 and 2008. These patients were implanted 125I with dose of 120e160 Gy. The treatment response, local control rate and survive rate were evaluated and the adverse events were observed. Results: Tumors of twenty-nine patients were got complete remission(CR), tumors of seven patients were partial remission(PR), the response rate was 83.7%. The patients were followed up 8e48 months (median 21 months), local control rate was 79%, total survival rate was 76.7%. No serious side radiotherapeutic effect was observed. Conclusions: Radioactivity seeds interstitial brachytherapy is an effective form of treatment for patients with unresectable malignant salivary gland tumors.
PD81 Image-Guided 125I Permanent Implantation as Salvage Therapy for Recurrent Head and Neck Carcinoma After Surgery and Radiotherapy Yuliang Jiang, MD1, Junjie Wang, MD, PhD1, Ping Jiang, MD1, Weiqiang Ran, MD2, Huishu Yuan, MD3, Ruijie Yang, MD, PhD1. 1Radiation Oncology, Peking University, Beijing, China; 2Ultrasound, Peking University, Beijing, Beijing, China; 3Radiology, Peking University, Beijing, China. Purpose: The management of recurrent head and neck cancer pose a challenging problem. We studied the efficacy and safety of 125I seed implantation for recurrent head and neck carcinoma after syrgery and radiotherapy. Materials and Methods: Between Jan 2004 and Dec 2009, 19 patients with recurrent head and neck carcinoma after surgery and radiotherapy underwent 125I seed implantation under CT or ultrasound guidance. The post-plan showed that the actuarial D90 of 125I seeds ranged from 90 to 160 Gy (median, 131 Gy).
The isodose curve distribution after seed implant.
PD82 Prolonged Stent Patency With Endoscopic Assisted HDR-192IR-ILBT in the Management of Malignant Biliary Obstruction Gian Carlo Mattiucci, Medical School1, Carla Germana Rinaldi, Medical School1, Luca Tagliaferri, Medical School1, Joao Ausem, Medical School1, Mario Balducci, Medical School1, Berardino De Bari, Medical School1, Daniela Smaniotto, Medical School1, Andrea Tringali, Medical School2, Massimiliano Mutignani, Medical School2, Guido Costamagna, Medical School2, Numa Cellini, Medical School1. 1Radiation Oncology, Catholic University of the Sacred Heart, Rome, Italy; 2Digestive Endoscopy, Catholic University of the Sacred Heart, Rome, Italy. Purpose: To evaluate the feasibility and safety of endoscopic assisted highdose-rate intraluminal brachytherapy (HDR-192Ir-ILBT) in the palliative treatment of extrahepatic biliary tract cancer with a focus on acute and late toxicity, stent patency and overall survival. Materials and Methods: Elegibility criteria included patients with non metastatic extrahepatic biliary cancer, age more than 79 years or younger patients unsuitable for surgical resection or radiochemotherapy for comorbidities or ECOG performance score more than 2. Patients were treated with implantation of metal stents placed during endoscopic retrograde cholangiopancreatography followed by HDR-192Ir-ILBT. Patients were evaluated for acute and late toxicity, stent patency and survival. Biliary patency was monitored with serial bilirubin levels, alkaline phosphatase levels, and/or cholangiography (if clinical findings suggested stent occlusion). Stents were considered patent in the absence of worsening jaundice with or without cholangitis. Survival rates were calculated from the time of placement of the metallic stent. Results: From May 2004 to April 2010, biliary drainage using selfexpandable metal stents was performed in 22 patients (10 females, 12 males; mean age 79,5; 11 common bile duct tumors,4 Klatskin I tumors, 3 Klatskin II and 4 Klatskin III) before HDR-192Ir-ILBT. In 3 patients we used 3 stents, in 5 and 14 patients we used respectively 2 and 1 stent. In all cases a complete drainage of the biliary tract was reached. After this procedure one patient experienced acute pancreatitis (one common