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Postoperative Radiotherapy for Low Grade Glioma of the Brain.

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2000;18(2):79-84.

PURPOSE: To evaluate the effectiveness and tolerance of postoperative external beam radiotherapy for patients with low grade glioma of the brain and define the optimal radiotherapeutic regimen. MATERIALS AND METHODS: Between June, 1985 and May, 1998, 72 patients with low grade gliomas were treated with postoperative radiotherapy immediately following surgery. Median age was 37 years with range of 11 to 76 years. Forty one patients were male and 31 patients were female with male to female ratio of 1.3:1. Of those patients, 15 underwent biopsy alone and remaining 57 did subtotal resection. The distribution of the patients according to histologic type was as follows: astrocytomas-42 patients (58%), mixed oligodendrogliomas-19 patients (27%), oligodendrogliomas-11 patients (15%). Two patients were treated with whole brain irradiation followed by cone down boost and remaining 70 patients were treated with localized field with appropriate margin. All of the patients were treated with conventional once a day fractionation. Most of patients received total tumor dose of 5000~5500 cGy. RESULTS: The overall 5 and 7 year survival rates for entire group of 72 patients were 61% and 50%. Corresponding disease free survival rates for entire patients were 53% and 45%, respectively. The 5 and 7 year overall survival rates for astrocytomas, mixed oligodendrogliomas, and oligodendrogliomas were 48% and 45%, 76% and 56%, and 80% and 52%, respectively. Patients who underwent subtotal resection showed better survival rates than those who did biopsy alone. The overall 5 year survival rates for subtotal resection patients and biopsy alone patients were 67% and 43%, respectively. Forty six patients who were 40 years or younger survived better than 26 patients who were 41 years or older (overall survival rate at 5 years, 69% vs 45%). Although one patient was not able to complete the treatment because of neurological deterioration, there was no significant treatment related acute toxicities. CONCLUSION: Postoperative radiotherapy was safe and effective treatment for patients with low grade gliomas. However, we probably need prospective randomized trial to define optimal treatment timing and schedule for low grade gliomas and select patient group for different treatment philosophies.
Appointments and Schedules ; Astrocytoma ; Biopsy ; Brain* ; Disease-Free Survival ; Female ; Glioma* ; Humans ; Male ; Oligodendroglioma ; Philosophy ; Radiotherapy* ; Survival Rate

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Patients Setup Verification Tool for RT (PSVTs): DRR, Simulation, Portal and Digital images.

Suk LEE ; Jinsil SEONG ; Soo Il KWON ; Sung Sil CHU ; Chang Geol LEE ; Chang Ok SUH

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2003;21(1):100-106.

PURPOSE: To develop a patients' setup verification tool (PSVT) to verify the alignment of the machine and the target isocenters, and the reproducibility of patients' setup for three dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT). The utilization of this system is evaluated through phantom and patient case studies. MATERIALS AND METHODS: We developed and clinically tested a new method for patients' setup verification, using digitally reconstructed radiography (DRR), simulation, portal and digital images. The PSVT system was networked to a Pentium PC for the transmission of the acquired images to the PC for analysis. To verify the alignment of the machine and target isocenters, orthogonal pairs of simulation images were used as verification images. Errors in the isocenter alignment were measured by comparing the verification images with DRR of CT images. Orthogonal films were taken of all the patients once a week. These verification films were compared with the DRR were used for the treatment setup. By performing this procedure every treatment, using humanoid phantom and patient cases, the errors of localization can be analyzed, with adjustments made from the translation. The reproducibility of the patients' setup was verified using portal and digital images. RESULTS: The PSVT system was developed to verify the alignment of the machine and the target isocenters, and the reproducibility of the patients' setup for 3DCRT and IMRT. The results show that the localization errors are 0.8+/-0.2 mm (AP) and 1.0+/-0.3 mm (Lateral) in the cases relating to the brain and 1.1+/-0.5 mm (AP) and 1.0+/-0.6 mm (Lateral) in the cases relating to the pelvis. The reproducibility of the patients' setup was verified by visualization, using real-time image acquisition, leading to the practical utilization of our software. CONCLUSION: A PSVT system was developed for the verification of the alignment between machine and the target isocenters, and the reproducibility of the patients' setup in 3DCRT and IMRT. With adjustment of the completed GUI-based algorithm, and a good quality DRR image, our software may be used for clinical applications.
Brain ; Humans ; Pelvis ; Radiography ; Radiotherapy ; Radiotherapy, Conformal

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Technical Review of Target Volume Delineation on the Posterior Fossa Tumor:An Optimal Head and Neck Position.

Sang Min YOON ; Sang wook LEE ; Seung Do AHN ; Jong Hoon KIM ; Byong Yong YI ; Young Shin RA ; Thad GHIM ; Eun Kyung CHOI

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2003;21(1):94-99.

PURPOSE: To explore a 3D conformal radiotherapy technique for a posterior fossa boost, and the potential advantages of a prone position for such radiotherapy. MATERIALS AND METHODS: A CT simulator and 3D conformal radiotherapy planning system was used for the posterior fossa boost treatment of a 13-year-old medulloblastoma patient. He was placed in the prone position and immobilized with an aquaplast mask and immobilization mold. CT scans were obtained of the brain from the top of the skull to the lower neck, with IV contrast enhancement. The target volume and normal structures were delineated on each slice, with treatment planning performed using non-coplanar conformal beams. RESULTS: The CT scans, and treatment in the prone position, were performed successfully. In the prone position, the definition of the target volume was made easier due to the well enhanced tentorium. In addition, the posterior fossa was located anteriorly, and with the greater choice of beam arrangements, more accurate treatment planning was possible as the primary beams were not obstructed by the treatment table. CONCLUSION: A posterior fossa boost, in the prone position, is feasible in cooperating patients, but further evaluation is needed to define the optimal and most comfortable treatment positions.
Adolescent ; Brain ; Carboxymethylcellulose Sodium ; Fungi ; Head* ; Humans ; Immobilization ; Masks ; Medulloblastoma ; Neck* ; Prone Position ; Radiotherapy ; Radiotherapy, Conformal ; Skull ; Tomography, X-Ray Computed

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The Benefit of Individualized Custom Bolus in the Postmastectomy Radiation Therapy:Numerical Analysis with 3-D Treatment Planning.

Jae Ho CHO ; Kwang Hwan CHO ; Kichang KEUM ; Yongyih HAN ; Yong Bae KIM ; Sung Sil CHU ; Chang Ok SUH

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2003;21(1):82-93.

PURPOSE: To reduce the irradiation dose to the lungs and heart in the case of chest wall irradiation using an oppositional electron beam, we used an individualized custom bolus, which was precisely designed to compensate for the differences in chest wall thickness. The benefits were evaluated by comparing the normal tissue complication probabilities (NTCPs) and dose statistics both with and without boluses. MATERIALS AND METHODS: Boluses were made, and their effects evaluated in ten patients treated using the reverse hockey-stick technique. The electron beam energy was determined so as to administer 80% of the irradiation prescription dose to the deepest lung-chest wall border, which was usually located at the internal mammary lymph node chain. An individualized custom bolus was prepared to compensate for a chest wall thinner than the prescription depth by meticulously measuring the chest wall thickness at 1 cm2 intervals on the planning CT images. A second planning CT was obtained overlying the individualized custom bolus for each patient's chest wall. 3-D treatment planning was performed using ADAC-Pinnacle3 for all patients with and without bolus. NTCPs based on "the Lyman-Kutcher" model were analyzed and the mean, maximum, minimum doses, V50 and V95 for the heart and lungs were computed. RESULTS: The average NTCPs in the ipsilateral lung showed a statistically significant reduction (p<0.01), from 80.2+/-3.43% to 47.7+/-4.61%, with the use of the individualized custom boluses. The mean lung irradiation dose to the ipsilateral lung was also significantly reduced by about 430 cGy, from 2757 cGy to 2,327 cGy (p<0.01). The V50 and V95 in the ipsilateral lung markedly decreased from the averages of 54.5 and 17.4% to 45.3 and 11.0%, respectively. The V50 and V95 in the heart also decreased from the averages of 16.8 and 6.1% to 9.8% and 2.2%, respectively. The NTCP in the contralateral lung and the heart were 0%, even for the cases with no bolus because of the small effective mean radiation volume values of 4.4 and 7.1%, respectively. CONCLUSION: The use of an individualized custom bolus in the radiotherapy of postmastectomy chest wall reduced the NTCP of the ipsilateral lung by about 24.5 to 40.5%, which can improve the complication free cure probability of breast cancer patients.
Breast Neoplasms ; Heart ; Humans ; Lung ; Lymph Nodes ; Prescriptions ; Radiation Pneumonitis ; Radiotherapy ; Thoracic Wall

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Radiation-Induced Apoptosis of Lymphocytes in Peripheral Blood.

Yoon Kyeong OH ; Tae Bum LEE ; Taek Keun NAM ; Keun Hong KEE ; Cheol Hee CHOI

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2003;21(1):75-81.

PURPOSE: This study quantitatively evaluated the apoptosis in human peripheral blood lymphocytes using flow cytometry, and investigated the possibility of using this method, with a small amount of blood, and the time and dose dependence of radiation-induced apoptosis. MATERIALS AND METHODS: Peripheral blood lymphocytes were isolated from the heparinized venous blood of 11 healthy volunteers, 8 men and 3 women, with each 10 ml of blood being divided into 15 samples. The blood lymphocytes were irradiated using a linear accelerator at a dose rate of 2.4 Gy/min, to deliver doses of 0.5, 1, 2 and 5 Gy. The control samples, and irradiated cells, were maintained in culture medium for 24, 48 and 72 hours following the irradiation. The number of apoptotic cells after the in vitro X-irradiation was measured by flow cytometry after incubation periods of 24, 48 and 72 hours. We also observed the apoptotic cells using a DNA fragmentation assay and electron microscopy. RESULTS: The rate of spontaneous apoptosis increased in relation to the time interval following irradiation (1.761+/-0.161, 3.563+/-0.564, 11.098+/-2.849, at 24, 48, and 72 hours). The apoptotic cells also increased in the samples irradiated with 0.5, 1, 2 and 5 Gy, in a radiation dose and time interval after irradiation manner, with the apoptosis being too great at 72 hours after irradiation. The dose-response curves were characterized by an initial steep increase in the number of apoptotic cells for irradiation doses below 2 Gy, with a flattening of the curves as the dose approached towards 5 Gy. CONCLUSION: The flow cytometric assay technique yielded adequate data, and required less than 1 mL of blood. The time and dose dependence of the radiation-induced apoptosis, was also shown. It is suggested that the adequate time interval required for the evaluation of apoptosis would be 24 to 48 hours after blood sampling.
Apoptosis* ; DNA Fragmentation ; Female ; Flow Cytometry ; Healthy Volunteers ; Heparin ; Humans ; Lymphocytes* ; Male ; Microscopy, Electron ; Particle Accelerators

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Expression of Matrix Metalloproteinase-2 and Tissue Inhibitor of Metalloproteinase-2 in Radiation Exposed Small Intestinal Mucosa of the Rat.

Hyon Joo KWAG ; Kyoung Ja LEE ; Chung Sik RHEE

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2003;21(1):66-74.

PURPOSE: The matrix metalloproteinases (MMPs) are a family of enzymes whose main function is the degradation of the extracellular matrix. Several studies have revealed that MMPs and TIMPs are related to the wound healing process and in photoaging caused by ultraviolet irradiation. However, the expressions of MMP and TIMP after irradiation have not, to the best of our knowledge, been studied. This study investigates the expressions of MMP-2 and TIMP-2 in rat intestinal mucosa following irradiation. Material and Methods:The entire abdomen of Sprague-Dawley rats was irradiated using a single dose method. The rats were sacrificed on day 1, 2, 3, 5, 7 and 14 following irradiation. Histopathological observations were made using hematoxilin & eosin staining. The expressions of MMP-2 and TIMP-2 were examined using immunohistochemistry, immunoblotting and ELISA. RESULTS: Radiation induced damage, associated with atrophic villi, and infiltration of inflammatory cells was observed from the first postirradiation day, and severe tissue damage was observed on the second and the third postirradiation days. An increase in mitosis and the number of regenerating crypts, as evidence of regeneration, were most noticeable on the fifth postirradiation day. From the immunohistochemistry, the MMP-2 expression was observed from the first postirradiation day, but was most conspicuous on the third and the fifth postirradiation days. The TIMP-2 expression was most conspicuous on the fifth postirradiation day. From the immunoblotting, the MMP-2 expression was strongly positive on the third postirradiation day, and that of TIMP-2 showed a strong positive response on the fifth postirradiation day. In ELISA tests, the expressions of MMP-2 and TIMP-2 were increased in the postirradiation groups compared to those of the normal controls, and showed a maximum increase on the fifth postirradiation day. These results were statistically significant. CONCLUSION: The expressions of MMP-2 and TIMP-2 were increased in the intestinal mucosa of the rats following irradiation, and these results correlated with the histopathological findings, such as tissue damage and regeneration. Therefore, this study suggests that MMP-2 and TIMP-2 play roles in the mechanisms of radiation-induced damage and regeneration of intestinal mucosa of rats.
Abdomen ; Animals ; Enzyme-Linked Immunosorbent Assay ; Eosine Yellowish-(YS) ; Extracellular Matrix ; Humans ; Immunoblotting ; Immunohistochemistry ; Intestinal Mucosa* ; Matrix Metalloproteinase 2* ; Matrix Metalloproteinases ; Mitosis ; Rats* ; Rats, Sprague-Dawley ; Regeneration ; Tissue Inhibitor of Metalloproteinase-2* ; Wound Healing

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Gene Expression Profiles in Cervical Cancer with Radiation Therapy Alone and Chemo-radiation Therapy.

Kyu Chan LEE ; Meyoung kon KIM ; Jooyoung KIM ; You Jin HWANG ; Myung Sun CHOI ; Chul Yong KIM

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2003;21(1):54-65.

PURPOSE: To analyze the gene expression profiles of uterine cervical cancer, and its variation after radiation therapy, with or without concurrent chemotherapy, using a cDNA microarray. MATERIALS AND METHODS: Sixteen patients, 8 with squamous cell carcinomas of the uterine cervix, who were treated with radiation alone, and the other 8 treated with concurrent chemo-radiation, were included in the study. Before the starting of the treatment, tumor biopsies were carried out, and the second time biopsies were performed after a radiation dose of 16.2~27 Gy. Three normal cervix tissues were used as a control group. The microarray experiments were performed with 5 groups of the total RNAs extracted individually and then admixed as control, pre-radiation therapy alone, during-radiation therapy alone, pre-chemoradiation therapy, and during-chemoradiation therapy. The 33P-labeled cDNAs were synthesized from the total RNAs of each group, by reverse transcription, and then they were hybridized to the cDNA microarray membrane. The gene expression of each microarrays was captured by the intensity of each spot produced by the radioactive isotopes. The pixels per spot were counted with an Arrayguage(R), and were exported to Microsoft Excel(R). The data were normalized by the Z transformation, and the comparisons were performed on the Z-ratio values calculated. RESULTS: The expressions of 15 genes, including integrin linked kinase (ILK), CDC28 protein kinase 2, Spry 2, and ERK 3, were increased with the Z-ratio values of over 2.0 for the cervix cancer tissues compared to those for the normal controls. Those genes were involved in cell growth and proliferation, cell cycle control, or signal transduction. The expressions of the other 6 genes, including G protein coupled receptor kinase 6, were decreased with the Z-ratio values of below -2.0. After the radiation therapy, most of the genes, with a previously increase expressions, represented the decreased expression profiles, and the genes, with the Z-ratio values of over 2.0, were cyclic nucleotide gated channel and 3 Expressed sequence tags (EST). In the concurrent chemo-radiation group, the genes involved in cell growth and proliferation, cell cycle control, and signal transduction were shown to have increased expressions compared to the radiation therapy alone group. The expressions of genes involved in angiogenesis (angiopoietin-2), immune reactions (formyl peptide receptor-like 1), and DNA repair (cAMP phosphodiesterase) were increased, however, the expression of gene involved in apoptosis (death associated protein kinase) was decreased. CONCLUSION: The different kinds of genes involved in the development and progression of cervical cancer were identified with the cDNA microarray, and the proposed theory is that the proliferation signal starts with ILK, and is amplified with Spry 2 and MAPK signaling, and the cellular mitoses are increased with the increased expression of Cdc 2 and cell division kinases. After the radiation therapy, the expression profiles demonstrated the evidence of the decreased cancer cell proliferation. There was no significant difference in the morphological findings of cell death between the radiation therapy alone and the chemo-radiation groups in the second time biopsy specimen, however, the gene expression profiles were markedly different, and the mechanism at the molecular level needs further study.
Apoptosis ; Biopsy ; Carcinoma, Squamous Cell ; Cell Death ; Cell Division ; Cell Proliferation ; Centers for Disease Control and Prevention (U.S.) ; Cervix Uteri ; Cyclic Nucleotide-Gated Cation Channels ; DNA Repair ; DNA, Complementary ; Drug Therapy ; Expressed Sequence Tags ; Female ; Gene Expression* ; GTP-Binding Proteins ; Humans ; Membranes ; Mitosis ; Oligonucleotide Array Sequence Analysis ; Phosphotransferases ; Protein Kinases ; Radioisotopes ; Reverse Transcription ; RNA ; Signal Transduction ; Transcriptome* ; Uterine Cervical Neoplasms*

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Survey on Radiotherpy Protocols for the Rectal Cancers among the Korean Radiation Oncologists in 2002 for the Development of the Patterns of Care Study of Radiation Therapy.

Jong Hoon KIM ; Dae Yong KIM ; Yong Ho KIM ; Woo Cheol KIM ; Chul Yong KIM ; Jinsil SEONG ; Seung Chang SOHN ; Hyun Soo SHIN ; Yong Chan AHN ; Do Hoon OH ; Wong Yong OH ; Mi Ryeong RYU ; Hyung Jun YOO ; Kyung Ja LEE ; Kyu Chan LEE ; Mison CHUN ; Ha Jung CHUN ; Seong Eon HONG ; Il Han KIM

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2003;21(1):44-53.

PURPOSE: To conduct a nationwide survery on the principles in radiotherapy for rectal cancer, and develop the framework of a database of Korean Patterns of Care Study. MATERIALS AND METHODS: A consensus committee was established to develop a tool for measuring the patterns in radiotherapy protocols for rectal cancer. The panel was composed of radiation oncologists from 18 hospitals in Seoul Metropolitan area. The committee developed a survey format to analyze radiation oncologist's treatment principles for rectal cancer. The survey items developed for measuring the treatment principles were composed of 1) 8 eligibility criteria, 2) 20 items for staging work-ups and prognostic factors, 3) 7 items for principles of combined surgery and chemotherapy, 4) 9 patient set-ups, 5) 19 determining radiation fields, 6) 5 radiotherapy treatment plans, 7) 4 physical/laboratory examination to monitor a patient's condition during treatment, and 8) 10 follow-up evaluations. These items were sent to radiation oncologists in charge of gastrointestinal malignancies in all hospitals (48 hospitals) in Korea to which 30 replies were received (63%). RESULTS: Most of the survey items were replied to without no major differences between the repliers, but with the following items only 50% of repliers were in agreement:1) indications of preoperative radiation, 2) use of endorectal ultrasound, CT scan, and bone scan for staging work-ups, 3) principles of combining chemotherapy with radiotherapy, 4) use of contrast material for small bowel delineation during simulation, 5) determination of field margins, and 6) use of CEA and colonoscopy for follow-up evaluations. CONCLUSION: The items where considerable disagreement was shown among the radiation oncologists seemed to make no serious difference in the treatment outcome, but a practical and reasonable consensus should be reached by the committee, with logical processes of agreement. These items can be used for a basic database for the Patterns of Care Study, which will survey the practical radiotherapy patterns for rectal cancer in Korea.
Colonoscopy ; Consensus ; Drug Therapy ; Follow-Up Studies ; Humans ; Korea ; Logic ; Radiotherapy ; Rectal Neoplasms* ; Seoul ; Tomography, X-Ray Computed ; Treatment Outcome ; Ultrasonography

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High-Dose-Rate Intraluminal Brachytherapy for Biliary Obstruction by Secondary Malignant Biliary Tumors.

Won Sup YOON ; Tae Hyun KIM ; Dae Sik YANG ; Myung Sun CHOI ; Chul Yong KIM

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2003;21(1):35-43.

PURPOSE: To analyze the survival period, prognostic factors and complications of patients having undergone high-dose-rate intraluminal brachytherapy (HDR-ILB) as a salvage radiation therapy, while having a catheter, for percutaneous transhepatic biliary drainage (PTBD), inserted due to biliary obstruction caused by a secondary malignant biliary tumor. METHODS AND MATERIALS: A retrospective study was performed on 24 patients having undergone HDR- ILB, with PTBD catheter insertion, between December 1992 and August 2001. Their median age was 58.5, ranging from 35 to 82 years. The primary cancer site were the stomach, gallbladder, liver, pancreas and the colon, with 12, 6, 3, 2 and 1 cases, respectively. Eighteen patients were treated with external beam radiation therapy and HDR-ILB, while six were treated with HDR-ILB only. The total external beam, and brachytherapy radiations dose were 30~61.2 and 9~30 Gy, with median doses of 50 and 15 Gy, respectively. RESULTS: Of the 24 patients analyzed, 22 died during the follow-up period, with a median survival of 7.3 months. The 6 and 12 months survival rates were 54.2 (13 patients) and 20.8% (5 patients), respectively. The median survivals for stomach and gallbladder cancers were 7.8 and 10.2 months, respectively. According to the univariate analysis, a significant factor affecting survival of over one year was the total radiation dose (over 50 Gy) (p=0.0200), with all the patients surviving more than one year had been irradiated with more than 50 Gy. The acute side effects during the radiation therapy were managed with conservative treatment. During the follow-up period, 5 patients showed symptoms of cholangitis due to the radiation therapy. CONCLUSION: An extension to the survival of those patients treated with HDR-ILB is suggested compared to the median historical survival of those patients treated with external biliary drainage. A boost radiation dose could be effectively given, by performing HDR-ILB, which is a prognostic factor. In addition, the acute complications of radiation therapy were effectively controlled by conservative management, and it could be regarded as a safe treatment.
Brachytherapy* ; Catheters ; Cholangitis ; Colon ; Drainage ; Follow-Up Studies ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Liver ; Pancreas ; Retrospective Studies ; Stomach ; Survival Rate

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Treatment Outcome of Postoperative Radiotherapy in Extrahepatic Bile Duct Cancer.

Youngmin CHOI ; Heunglae CHO

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2003;21(1):27-34.

PURPOSE: To evaluate the efficacy of radiotherapy, and the factors affecting survival in patients of extrahepatic bile duct cancer, by analyzing the results of postoperative radiotherapy. MATERIALS AND METHODS: Between October 1991 and July 2001, 21 patients with extrahepatic bile duct cancer, who received radiotherapy after a radical resection, were retrospectively reviewed. The patients' ages ranged from 39 to 75 years, with a median of 61 years, and a male to female ratio of 16 to 5. The numbers of patients with proximal and distal bile duct cancer were 14 and 7, respectively. From the postoperative pathological examination, 19 of the patients were found to have microscopic residues, and 7 to be lymph node positive. Patients with AJCC stages I, II and III were 10, 10 and 1, respectively. The total radiation dose administered was 4,500~6,300 cGy, with a median dose of 5,040 cGy. The follow up period was 20~81 months, with a median of 57.5 months. RESULTS: The overall and disease free survival rates at 3 and 5 years were 41.0 and 29.3%, and 41.6 and 29.7%, respectively. The influences of age, sex, tumor location, differentiation, microscopic residue, neural invasion, T and N stage, the stage itself, the dose of radiation and chemotherapy, on survival were evaluated. The T stage and the stage itself were found to be significant from a univariate analysis (p< 0.05), but the degree of significance was limited by the small number of patients. A recurrence occurred in 12 patients (57.1%), 5 in locoregional sites, 4 in distant sites and 3 in a combination of locoregional and distant sites, and the sites of distant metastasis were the liver, 6, and the bone, 1. Grade 2 or 3 acute leucopenias occurred in 2 patients and grade 2 chronic peptic ulcers occurred in 4, who were all recovered by conservative management. CONCLUSION: Postoperative radiotherapy is feasible in extrahepatic bile duct cancer, with tolerable toxicity, but prospective studies, with a large patient enrollment, are needed for the evaluation of the effects of postoperative radiotherapy and the related prognostic factors.
Bile Duct Neoplasms ; Bile Ducts, Extrahepatic* ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Liver ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Peptic Ulcer ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Treatment Outcome*

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