Photodynamic therapy for palliation of nonresectable bile duct cancer—preliminary results with a new diode laser system

Abstract

PDT with the diode laser system seems to be effective in reducing malignant bile duct stenosis. This treatment is minimally invasive and has a low specific complication rate. Randomized, controlled studies comparing PDT with the insertion of endoprostheses and long term follow-up of results are needed to confirm the promising short term results.

Photodynamic Therapy for Cholangiocarcinoma

“…Similar short patency times have recently been reported for uncoated Wallstents placed after PDT in a prospective series of 24 patients with CC. 12 A coated metal stent would prevent restenosis but shield from laser light and hinder PDT treatment. Therefore, PDT for CC should be combined with the insertion of exchangeable plastic endoprostheses.…”

“…The conditions they had established are still in use for PDT of CC, including the dose of photosensitizer, the laser light power, and irradiance. [8][9][10][11][12][13][14][15] In a pilot study on 9 patients with perihilar CC, Ortner et al 8 established the PDT procedure with porfimer via the transpapillary cholangioscopic access for laser light illumination of the tumor stenosis under direct visual control and showed improved palliation for obstructive cholestasis. We used a more convenient ERC approach with transcatheter laser light illumination, if necessary, in repeated ERC sessions up to day 4 after administration of porfimer.…”

“…We used a more convenient ERC approach with transcatheter laser light illumination, if necessary, in repeated ERC sessions up to day 4 after administration of porfimer. Meanwhile transcatheter laser light application via ERC access has become the preferred PDT technique for CC in most centers 10,[12][13][14] because it permits therapeutic intervention of occluded lobar and segmental bile ducts (Fig. 2).…”

“…10,14 Bleeding could be stopped with selective arterial embolization or endoscopic intervention, or both. 8 Berr et al 10 Rumalla et al 11 Zoepf et al 12 Dumoulin et al 13 Ortner et al 14 y Cholangitis was defined as putrid bile or bacterial culture-positive bile in presence of an increase of C-reactive protein (CRP) and white blood cells (WBC).…”

“…[1][2][3][4][5][6] PDT has been evaluated only for perihilar CC with extension along the common bile duct. [7][8][9][10][11][12][13][14][15] There is no reason to apply PDT to intrahepatic peripheral CCs, which usually are multifocal or bulky when nonresectable, or to distal extrahepatic CCs, which are best managed by curative resection or palliative insertion of a metal stent and radiotherapy or chemotherapy. 1,[16][17][18]…”