Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2015; 21(1): 373-376
Published online Jan 7, 2015. doi: 10.3748/wjg.v21.i1.373
Placement of 125I seed strands and stents for a type IV Klatskin tumor
Wen Zhang, Zheng-Qiang Yang, Hai-Bin Shi, Shen Liu, Wei-Zhong Zhou, Lin-Bo Zhao
Wen Zhang, Zheng-Qiang Yang, Hai-Bin Shi, Shen Liu, Wei-Zhong Zhou, Lin-Bo Zhao, Department of Interventional Radiology, First Affiliate Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Author contributions: Zhang W wrote this paper; Yang ZQ designed the study; Shi HB, Liu S, Zhou WZ and Zhao LB reviewed and revised the report.
Supported by Peak of Six Personnel in Jiangsu Province, No. 2013-WSN-038
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zheng-Qiang Yang, MD, Department of Interventional Radiology, First Affiliate Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China. ntdoctoryang@hotmail.com
Telephone: +86-25-68136918 Fax: +86-25-83719809
Received: April 12, 2014
Peer-review started: April 14, 2014
First decision: May 13, 2014
Revised: June 12, 2014
Accepted: July 11, 2014
Article in press: July 11, 2014
Published online: January 7, 2015
Abstract

Herein, we report a new technique that consists of placing two 125I seed strands and two stents in the right and left intrahepatic bile ducts for the treatment of hilar cholangiocarcinoma. A 75-year-old man presented with jaundice and was diagnosed with Bismuth type IV Klatskin tumor. Abdominal computed tomography (CT) showed intrahepatic and extrahepatic bile duct dilatation and a soft tissue mass in the hepatic hilum. Because curative surgical resection was not possible, we placed 125I seed strands and stents in the right and left intrahepatic bile ducts. Three months later, abdominal CT showed less intrahepatic and extrahepatic bile duct dilatation than before the procedure. This technique was feasible and could be considered for the treatment of patients with Bismuth type IV tumors.

Keywords: Cholangiocarcinoma, Klatskin tumor, 125I seed strands, Stent, Bismuth type IV, Bile duct

Core tip: Treatment of Klatskin tumor remains difficult. Although brachytherapy using 125I seed strands was reported for treatment of cholangiocarcinoma, to our knowledge, the use of 125I seed strands has seldom been reported for the treatment of type IV Klatskin tumors. Herein, we describe a patient with a Bismuth type IV Klatskin tumor who was treated via the placement of two 125I seed strands and two stents in the right and left intrahepatic bile ducts, which provided both brachytherapy and biliary drainage. This technique may provide a novel method for prolonging survival in these patients.