Biliary drainage, photodynamic therapy and chemotherapy for unresectable cholangiocarcinoma with jaundice.
OBJECTIVE
The combination of photodynamic therapy and biliary stenting seems to be beneficial in the palliative treatment of unresectable cholangiocarcinoma. We aimed to assess the accuracy of photodynamic therapy in a single centre.


METHODS
Fourteen selected patients, with jaundice related to unresectable cholangiocarcinoma, underwent photodynamic therapy and biliary stenting (with or without chemotherapy). Photofrin was injected intravenously (2 mg/kg) 2 days before intraluminal photoactivation. In case of malignant progression, photodynamic therapy was repeated. The outcome parameters were overall survival and quality of life.


RESULTS
There were eight men and six women (median age: 67 [42-81]). Unresectability was related to a low Karnofski index (n = 2), peritoneal carcinomatosis (n = 4), vascular involvement (n = 3), invasion of the hepatoduodenal ligament (n = 2) and an under-sized liver remnant (n = 3). Biliary stenting was efficient (> or = 50% total bilirubin) in 78.5% of cases. Eight patients developed cholangitis. The mean number of photodynamic therapy procedures was two (1-4). Six (43%) patients needed > or = 2 procedures. No severe toxicity was noted. Photodynamic therapy improved the Karnofski index in 64% of cases. Six (42.8%) patients received concomitant chemotherapy (gemcitabine). The median survival time was 13.8 [0.7-29.2] months. The 3-, 6- and 12-month survival rates were 85%, 77% and 77%, respectively.


CONCLUSIONS
These results confirm the beneficial effect of biliary drainage, photodynamic therapy and chemotherapy for unresectable cholangiocarcinoma in selected patients with jaundice.
Federation of Digestive Diseases, Amiens North Hospital, Jules Verne University of Picardy, Amiens, France.
David
D
Fuks
Eric
E
Bartoli
Richard
R
Delcenserie
Thierry
T
Yzet
Pierre
P
Celice
Charles
C
Sabbagh
Denis
D
Chatelain
Jean-Paul
JP
Joly
Nathalie
N
Cheron
Jean-Louis
JL
Dupas
Jean-Marc
JM
Regimbeau
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001650:Bile Duct Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D001662:Biliary Tract Surgical Procedures; D018281:Cholangiocarcinoma / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation; D002761:Cholangitis / Q000209:etiology; D000075202:Contraindications; D017323:Dihematoporphyrin Ether / Q000008:administration & dosage; D018572:Disease-Free Survival; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007565:Jaundice / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010147:Pain Measurement; D010166:Palliative Care; D010778:Photochemotherapy / Q000009:adverse effects; D017319:Photosensitizing Agents / Q000008:administration & dosage; D011446:Prospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D017319:Photosensitizing Agents; D017323:Dihematoporphyrin Ether