Prospective study of the effectiveness of percutaneous transhepatic photodynamic therapy for advanced bile duct cancer and the role of intraductal ultrasonography in response assessment.
OBJECTIVE
We evaluated the therapeutic effects of percutaneous transhepatic photodynamic therapy (PDT) in patients with advanced bile duct cancer. The utility of intraductal ultrasonography (IDUS) for the assessment of responses and for regular follow up after PDT was also examined.


METHODS
Percutaneous transhepatic biliary drainage (PTBD) was initiated before PDT. Following dilation and maturation of the PTBD tract, percutaneous PDT was performed. Intraluminal photoactivation was carried out using percutaneous cholangioscopy 2 days after intravenous application of a hematoporphyrin derivative. All patients were additionally provided with percutaneous bile duct drainage catheters after PDT. IDUS was conducted monthly to measure the thickness of the tumor mass before and after PDT.


RESULTS
24 patients with advanced cholangiocarcinomas (Bismuth IIIa, n = 4; IIIb, n = 10; IV, n = 10) were treated with PDT. At 3 months after PDT, the mean thickness of the tumor mass had decreased from 8.7 +/- 3.7 mm to 5.8 +/- 2.0 mm (P < 0.01). At 4 months after PDT, the thickness of the mass had increased to 7.0 +/- 3.7 mm. Quality of life indices improved dramatically and remained stable 1 month after PDT; the Karnofsky index increased from 39.1 +/- 11.36 to 58.2 +/- 22.72 points (P = 0.003). The 30-day mortality rate was 0 %, and the median survival time was 558 +/- 178.8 days (current range 62 - 810 days).


CONCLUSIONS
PDT using percutaneous cholangioscopy is safe and effective for advanced hilar cholangiocarcinoma, and seems to prolong survival. IDUS is useful for evaluating changes in the thickness of the tumor mass after PDT.
Shim
C S
CS
Institute for Digestive Research and Digestive Disease Center, Soon Chun Hyang University College of Medicine, Seoul, Korea. schidr@hosp.sch.ac.kr
Cheon
Y K
YK
Cha
S W
SW
Bhandari
S
S
Moon
J H
JH
Cho
Y D
YD
Kim
Y S
YS
Lee
L S
LS
Lee
M S
MS
Kim
B S
BS
D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life; D015996:Survival Rate; D016896:Treatment Outcome