Biliary drainage, photodynamic therapy and chemotherapy for unresectable cholangiocarcinoma with jaundice

J Gastroenterol Hepatol. 2009 Nov;24(11):1745-52. doi: 10.1111/j.1440-1746.2009.05915.x. Epub 2009 Sep 25.

Abstract

Background and aim: The combination of photodynamic therapy and biliary stenting seems to be beneficial in the palliative treatment of unresectable cholangiocarcinoma. We aimed to assess the accuracy of photodynamic therapy in a single centre.

Methods: Fourteen selected patients, with jaundice related to unresectable cholangiocarcinoma, underwent photodynamic therapy and biliary stenting (with or without chemotherapy). Photofrin was injected intravenously (2 mg/kg) 2 days before intraluminal photoactivation. In case of malignant progression, photodynamic therapy was repeated. The outcome parameters were overall survival and quality of life.

Results: There were eight men and six women (median age: 67 [42-81]). Unresectability was related to a low Karnofski index (n = 2), peritoneal carcinomatosis (n = 4), vascular involvement (n = 3), invasion of the hepatoduodenal ligament (n = 2) and an under-sized liver remnant (n = 3). Biliary stenting was efficient (> or = 50% total bilirubin) in 78.5% of cases. Eight patients developed cholangitis. The mean number of photodynamic therapy procedures was two (1-4). Six (43%) patients needed > or = 2 procedures. No severe toxicity was noted. Photodynamic therapy improved the Karnofski index in 64% of cases. Six (42.8%) patients received concomitant chemotherapy (gemcitabine). The median survival time was 13.8 [0.7-29.2] months. The 3-, 6- and 12-month survival rates were 85%, 77% and 77%, respectively.

Conclusion: These results confirm the beneficial effect of biliary drainage, photodynamic therapy and chemotherapy for unresectable cholangiocarcinoma in selected patients with jaundice.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use*
  • Bile Duct Neoplasms / complications
  • Bile Duct Neoplasms / mortality
  • Bile Duct Neoplasms / pathology
  • Bile Duct Neoplasms / therapy*
  • Bile Ducts, Intrahepatic*
  • Biliary Tract Surgical Procedures
  • Cholangiocarcinoma / complications
  • Cholangiocarcinoma / mortality
  • Cholangiocarcinoma / pathology
  • Cholangiocarcinoma / therapy*
  • Cholangiopancreatography, Endoscopic Retrograde* / adverse effects
  • Cholangiopancreatography, Endoscopic Retrograde* / instrumentation
  • Cholangitis / etiology
  • Contraindications
  • Dihematoporphyrin Ether / administration & dosage
  • Disease-Free Survival
  • Drainage* / adverse effects
  • Drainage* / instrumentation
  • Female
  • Humans
  • Injections, Intravenous
  • Jaundice / etiology
  • Jaundice / mortality
  • Jaundice / pathology
  • Jaundice / therapy*
  • Kaplan-Meier Estimate
  • Karnofsky Performance Status
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Pain Measurement
  • Palliative Care
  • Photochemotherapy* / adverse effects
  • Photosensitizing Agents / administration & dosage
  • Prospective Studies
  • Stents
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Antineoplastic Agents
  • Photosensitizing Agents
  • Dihematoporphyrin Ether