Twenty evaluable patients with disseminated unresectable biliary tract cancer received chemotherapy after biliary tract drainage procedures. Two cambination chemotherapy protocols were applied; FAM (5-fluorouracil 1000 mg/m 24-hour infusion, day 1-3, adriamycin 40 mg/m i.v. day 1, mitomycin 10 mg/m i.v. day 1) in 13 patients, and MDF (5-fluorouracil 1000 mg/m' 24-hour infusion day 1-3, mitomycin 10 mg/m(2) i.v, day 1, cisplatin 80 mg/m i.v. day 4) in 7 patients. Course were repeated every three weeks. Seven patients(35%) achieved partial response. The median survival was 13.5 months in responders and 8.0 months in non-responders. No difference of drug response rate was observed between two chemotherapy protocols. Comparing the survival of biliary drainage plus chemotherapy group with that of billary drainage alone group, there was a trend of survival benefit in chemotherapy group with a median follow-up duration of 10 months. Gallbladder cancer and distal bile duct cancer showed favorable response rate and median survivals with chemotherapy and bile drainage than bile drainage alone. Most serious drug toxicities were myelosuppression and infection. But no chemotherapy related death was observed. Further randomized controlled trials to evaluate the effect of chemotherapy in advanced biliary tract cancer would be warrented.
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