Feasibility and safety of long-term photodynamic therapy (PDT) in the palliative treatment of patients with extrahepatic cholangiocarcinoma

Background and Aim: PDT is emerging as an important palliative option for patients with unresectable extrahepatic cholangiocarcinoma (CC). However, the results published to date reported on studies with no more than 6 (mostly up to 4) PDT procedures. Furthermore, the clinical experience of PDT in combination with chemotherapy is limited. The purpose of this retrospective analysis was to evaluate the feasibility and safety of multiple (4 to 14) settings of PDT, combined with biliary drainage, and (in some cases) with chemotherapy. Methods: Ten consecutive patients with unresectable extrahepatic CC were treated with biliary stenting and at least 4 PDT procedures in our department between 10/2005 and 08/2010. PDT was performed as described previously (1). Results: Ten patients (male/female=5/5), mean age 68.8 years (range, 54–81 years) which received at least 4 PDT procedures were analyzed. All patients underwent endoscopic biliary drainage. 9 patients received metallic stents and one patient a plastic stent. In 4 patients (40%) bilateral metal stenting (JoStent SelfX®) was performed as described previously (2). The mean number of PDT sessions was 7.9±3.9 (range: 4–14). Eight patients had elevated bilirubin levels with the mean bilirubin at admission of 9.9±11.3mg/dL, which decreased to an average minimum of 1.2±0.9mg/dL after 3 months. No severe toxicity was noted. Two patients received concomitant chemotherapy (GEMCIS as 1st line, GEMOX plus cetuximab as 2nd line). The median survival of all patients was 25.05 months. Conclusion: Long-term PDT in patients with extrahepatic CC is feasible and safe, and–at least in this cohort–accompanied by a median survival of more than two years.

Literature:

1. Dumoulin FL, Gerhardt T, Fuchs S, Scheurlen C, Neubrand M, Layer G, Sauerbruch T.Phase II study of photodynamic therapy and metal stent as palliative treatment for nonresectable hilar cholangiocarcinoma. Gastrointest Endosc 2003; 57:860-867. 2. Gerhardt T, Rings D, Höblinger A, Heller J, Sauerbruch T, Schepke M. Combination of bilateral metal stenting and trans-stent photodynamic therapy for palliative treatment of hilar cholangiocarcinoma. Z Gastroenterol 2010; 48:28-32.

chemotherapy - cholangiocarcinoma - palliative care - photodynamic therapy