Iodine-125 biliary stent for palliative treatment of locally advanced gallbladder cancer.

the gallbladder remains a challenging clinical problem. Intraluminal brachytherapy (ILBT) and interstitial brachytherapy (IBT) have been found to be effective in improving local control in patients with the advanced unresectable carcinoma. Our previous research demonstrated that the combination of radioactive stents and normal metallic or plastic stents was technically feasible and well tolerated by patients with advanced tumors around the pancreatic-head area [1]. A 74-year-old man was presented to our hospital with a 2-week history of abdominal distension and jaundice. A magnetic retrograde cholangiopancreatography (MRCP) scan showed a mass in the gallbladder neck, with calculi and gallstones in the commonbile duct. A computed tomographic (CT) scan showed carcinoma of gallbladder infiltrating the common bile duct (●" Fig. 1). The results of the laboratory investigations were as follows: white blood cell count 6.40 × 109/L; red blood cell count 4.02 × 1012/L; platelet count 197 × 109/L; total bilirubin 448.5 μmol/L, direct bilirubin 339.8 μmol/L, alanine aminotransferase 36 U/L, aspartate aminotransferase 33 U/L; and γ-glutamyltransferase 288 U/L. Renal function, alpha-fetoprotein, and carcinoembryonic antigen were normal, while the serum level of CA19-9 was 344.7 U/mL. An endoscopic retrograde cholangiopancreatography (ERCP) showed that the lower common bile duct was filled with stones. The ERCP also demonstrated irregular stenosis in the upper common bile duct and dilatation of the proximal intrahepatic duct. Endoscopic sphincterotomy was performed and the stones were successfully removed. An endoscopic retrograde brush was used during the operation, and a few days later, the cytology results confirmed the presence of adenocarcinoma. We then placed a special iodine-125 stent, in Iodine-125 biliary stent for palliative treatment of locally advanced gallbladder cancer