A case of cholangiocellular carcinoma with invasion to the liver hilum which was effectively treated by a combination of radiation therapy (Real-time tumor-tracking radiation therapy) and chemotherapy (gemcitabine)

Abstract

A 56-year-old female complaining of general fatigue, appetite loss and jaundice was referred to our hospital for further examination and to undergo treatment for a hilar liver tumor and dilation of the intrahepatic bile ducts. Abdominal CT demonstrated a hilar liver tumor measuring 60mm in size and multiple lymph node metastases. ERCP revealed that the tumor invaded the superior bile duct. After performing biliary drainage with a plastic stent, she was treated by combination therapy consisting of Real-time tumor-tracking radiation therapy and chemotherapy with gemcitabine. We changed the plastic stent to a metallic stent after the radiation therapy. Thereafter, the patient has been receiving gemcitabine infiltration once every two weeks. Sometimes the metallic stent became obstructed by debris and at such times stent cleaning using a balloon catheter was carried out. The tumor and lymph nodes both decreased in size and the tumor markers also decreased to the normal range. The patient is still alive at more than three years since the above therapeutic regimen was started.