目的：評估三度空間順形放射治療對於無法切除或術後殘餘的膽道癌之治療效果。材料與方法：從1997年9月至2005年8月，共28位局部無法切除（23位）或術後殘餘（5位）的膽道癌病人接受三度空間順形放射治療，治療劑量中位數為62.0Gy(21.6-70.0Gy/1.8-2.5Gy)，有7位病人亦接受化學治療。所有病人的追蹤時間之中位數為6.4個月。結果：疾病無惡化期(progression-free survival)的中位數為5.8個月，兩年的疾病無惡化率為10.7%；整體存活期(overall survival)的中位數為8.4個月，兩年的整體存活率為10.7%。在預後因子的單變數分析中，疾病無惡化期與整體存活期與病人的體能表現狀態、黃疸、放射治療劑量以及血清中CA19-9的濃度皆相關，疾病無惡化期亦與無法切除的腫瘤狀態有顯著相關。在多變數分析後，發現良好體能表現狀態（ECOG:0或1分）和較高的放射治療劑量(>50.0Gy)為獨立的預後因子，其病人不僅有較佳的疾病無惡化期（p<0.001和p=0.046），且也有較好的整體存活期（p<0.001和p=0.010）。在無消化性潰瘍病史的病人中，上消化道出血的發生率為18.2%，且相關併發症能用藥物來治療處理。結論：對於接受三度空間順形放射治療之患有無法切除或術後殘餘的膽道癌病人，體能表現狀態和放射治療劑量是影響治療結果的兩個重要預後因子。

Purpose: To evaluate the efficacy of three-dimensional conformal radiotherapy (3D-CRT) for unresectable or post-operative residual biliary tract carcinoma (BTC).Materials and Methods: From September 1997 to August 2005, twenty-eight patients with localized unresectable (23 patients) or post-operative residual (5 patients) BTC were treated by 3D-CRT. The median radiation dose was 62.0 Gy (21.6-70.0 Gy/1.8-2.5 Gy). Seven patients also underwent chemotherapy. The median follow-up time for all patients was 6.4 months.Results: The median progression-free survival (PFS) was 5.8 months and the 2-year actuarial PFS rate was 10.7%. The median overall survival (OS) was 8.4 months and the 2-year actuarial OS rate was 23.1%. In univariate analysis, both OS and PFS strongly correlate with the performance status, jaundice, radiation dose and serum carbohydrate antigen 19-9 level. The PFS also significantly associates with unresectable tumor status. After multivariate analysis: good performance status (ECOG: 0 or 1) and higher radiation dose (>50.0 Gy) were two independent prognostic factors which showed for patients with both PFS (p<0.001 and p=0.046, respectively) and OS (p<0.001 and p=0.010, respectively). The overall incidence of upper gastrointestinal bleeding in patients without any previous peptic ulcer history was 18.2% and the complications were medically manageable.Conclusions: The study demonstrated that performance status and RT dose are two predictors for outcome in patients treated with 3D-CRT for unresectable or postoperative residual BTC.