Photodynamic therapy of cholangiocarcinoma

Abstract

Photodynamic therapy (PDT) is a local photochemical tumor treatment that consists of a photosensitizing agent in combination with laser irradiation of a distinct wavelength. In some case reports and small non-randomized pilot studies, PDT has proved feasible in patients with hilar bile duct cancer. Those studies showed an astonishing long survival time of the treated patients. In the yet published two randomized controlled studies, PDT showed a significant extension of survival compared to sole bile duct stenting. A possible explanation for this improved survival is a suspected anti-tumor immunological effect induced by PDT. PDT reaches the same level of survival time as incomplete resection. The main complication is a high risk of severe bacterial cholangitis and liver abscesses requiring peri-interventional antibiotics. Skin phototoxicity, which at the beginning of PDT was the most dreaded potential complication, seems to play an ancillary role using mild light protection. As the available photosensitizers, mainly hematoporphyrin derivative (HPD), are not very effective in terms of depth of tumor necrosis, newer photosensitizers with light absorption in the near infrared spectrum and therefore deeper penetration depth are currently under investigation.

Synergic effect of photodynamic therapy using talaporfin sodium with conventional anticancer chemotherapy for the treatment of bile duct carcinoma

“…[2][3][4][5] Remarkably, PDT treatment induces a powerful anti-tumor immunological response. 6 In two randomized controlled trials, PDT provided a longer survival. 4,5 PDT treatment benefits have been reported for treating the targeted area in BDC patients who are receiving chemotherapy or adjuvant chemotherapy after surgery.…”

“…9 The first clinically approved photosensitizer, porfimer sodium (Photofrin ® ), is a hematoporphyrin derivative and has a very powerful cytocidal effect in BDC. [1][2][3][4][5][6][7][8] However, the anti-tumor effect was limited to the shallow bile duct wall because the 630 nm laser used in treatment had a low permeability. 10 Furthermore, the long period of skin photosensitivity required the patients to be kept away from strong sunlight for several weeks following the drug administration.…”

Advantages of laserphyrin compared with photofrin in photodynamic therapy for bile duct carcinoma

“…In two randomized controlled trials, PDT provided longer survival than bile duct stenting alone [6, 7]. A possible explanation for the improved survival is the powerful anti‐tumor immunological response induced by PDT [8]. Our group has also reported the benefits of PDT treatment in bile duct carcinoma as chemotherapy or adjuvant chemotherapy after surgery for local control [9].…”

Photodynamic Therapy for Cholangiocarcinoma

“…Three recent reviews that analyzed the contribution of photodynamic therapy to the treatment of cholangiocarcinoma all confirmed these data. 11,42,43 In 2007, Prasad et al 44 found that patients with unresectable cholangiocarcinoma without a visible mass benefited from early treatment with PDT. They described a technique for photodynamic therapy using percutaneous biliary access.…”