Aims:
Cancers of Vater's papilla and extrahepatic bile ducts are hardly accessible tumor
localizations characterized by extensive tumor growth and poor prognosis. Surgical
resection provides limited success with rather high recurrence rate. Photodynamic
therapy (PDT) is a new technique, providing both, adequate tumor destruction and minimal
damage to surrounding tissue.
The aim of this study was the development of PDT technique for the treatment of both
Vater's papilla and extrahepatic bile duct cancer in inoperable patients for improvement
of their quality of life and increase of their survival time.
Methods:
PDT has been performed in 29 patients. The average age was 68.5 years. Cancer of Vater's
papilla was diagnosed in 20 patients, cancer of the common bile duct in 3 patients,
cancer of the liver port in 1 patient, and cancer of the gall bladder in 4 patients.
Photoditazine (a chlorin-e6 derivative) was used as photosensitizer, diode laser was
used for irradiation via either endoscopic or transhepatic route. Patients were divided
into several groups. Outcomes were assessed by determining the median survival.
Results:
The treatment was well-tolerated by the patients. The median survival time was 18
months (minimum -11 months, maximum – 24 months. There were no lethal outcomes. In
patients who had only one PDT session during the year, the median survival was 12.5
months; in patients who had two or more PDT sessions, the median survival was 23 months.
Conclusions:
Results of PDT treatment for cancer of this localization are quite comparable with
the results of radical surgeries and are better than palliative surgeries.
Decrease of tumor growth rate and longer survival period in patients with residual
tumor after PDT treatment are determined by vascular mechanisms produced by PDT which
lead to vascular thrombosis and impaired tumor blood supply, these factors provide
long-term process stabilization. Repeated PDT courses significantly improve treatment
results.
