Photodynamic therapy of nonresectable cholangiocarcinoma.
OBJECTIVE
Successful treatment in nonresectable Bismuth type III and IV cholangiocarcinoma is seldom achieved. The aim of this study was to evaluate the effect of photodynamic therapy on cholestasis, quality of life, and survival in these patients.


METHODS
Nine patients with advanced nonresectable cholangiocarcinomas Bismuth type III and IV, who showed no sufficient drainage (bilirubin decrease <50%) after endoscopic stent insertion, underwent photodynamic therapy. Two days after intravenous application of a hematoporphyrin derivate, intraluminal photoactivation was performed cholangioscopically. Serum bilirubin, quality of life, and survival time were assessed in two monthly intervals after photodynamic therapy.


RESULTS
After photodynamic therapy, bilirubin serum levels declined from 318 +/- 72 to 103 +/- 35 micromol/L (P = 0.0039) with no significant increase during the two monthly follow-ups. Quality of life indices improved dramatically and remained stable (e.g., Karnofsky index from 32.2% +/- 8.13% to 68.9% +/- 6.1%; P = 0.0078). Thirty-day mortality was 0%, and median survival time was 439 days.


CONCLUSIONS
This study provides clear evidence that photodynamic therapy is effective in restoring biliary drainage and improving quality of life in patients with nonresectable disseminated cholangiocarcinomas Bismuth type III and IV. Compared with published data, survival time seems to be prolonged.
Ortner
M A
MA
Fourth Medical Department, Medical Faculty Charité, Humboldt University, Berlin, Germany.
Liebetruth
J
J
Schreiber
S
S
Hanft
M
M
Wruck
U
U
Fusco
V
V
Müller
J M
JM
Hörtnagl
H
H
Lochs
H
H
D001650:Bile Duct Neoplasms / Q000188:drug therapy*; D001653:Bile Ducts, Intrahepatic; D001663:Bilirubin / Q000097:blood; D018281:Cholangiocarcinoma / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007902:Length of Stay; D010778:Photochemotherapy / Q000009:adverse effects; D011788:Quality of Life; D015607:Stents; D015996:Survival Rate
D001663:Bilirubin