title: Photodynamic therapy for cholangiocarcinoma using low dose mTHPC (Foscan(®)).
abstract: BACKGROUND
  Photodynamic therapy (PDT) combined with stenting is an effective treatment modality for palliation of nonresectable cholangiocarcinoma (CC). A drawback of standard PDT using Photofrin(®) as photosensitizer is the long lasting skin photosensitivity of up to 3 months. The aim of this study was to show the outcome of PDT of CC, potential side effects and to determine the best drug light interval (DLI) using mTHPC (Foscan(®)) at a low dose.
  
  
  METHODS
  13 patients with nonresectable CC were treated with stenting and PDT (3mg Foscan(®) per treatment, 0.032-0.063 mg/kg body weight, 652 nm, 50 J/cm). Fluorescence measurements were performed with a single bare fiber for 5/13 patients prior to PDT at the tumor site to determine the fluorescence contrast. For another 7/13 patients, long-term fluorescence-kinetics were measured on the oral mucosa to determine the time of maximal relative fluorescence intensity.
  
  
  RESULTS
  The results so far indicate a median survival time of 13 months. Side effects such as perforations or skin phototoxicity could not be observed. Foscan(®) fluorescence within the tumor site was clearly detectable but a significant fluorescence contrast of tumor to adjacent healthy tissue could not be found. The fluorescence kinetics measured in the oral mucosa showed a maximum at 3.85 days (median) after drug administration.
  
  
  CONCLUSIONS
  Combined stenting and PDT performed with a low Foscan(®) dose results in equal and potentially longer survival times compared to standard Photofrin(®) PDT, while lowering the risk of side effects strongly. Thus it may improve the quality of life.
authors.affiliation: Laser-Forschungslabor, LIFE Center, University Hospital of Munich, Campus Großhadern, Marchioninistraße 23, 81377 Munich, Germany. gesa.kniebuehler@med.uni-muenchen.de
authors.forename: Gesa
authors.initials: G
authors.lastname: Kniebühler
authors.forename: Thomas
authors.initials: T
authors.lastname: Pongratz
authors.forename: Christian S
authors.initials: CS
authors.lastname: Betz
authors.forename: Burkhard
authors.initials: B
authors.lastname: Göke
authors.forename: Ronald
authors.initials: R
authors.lastname: Sroka
authors.forename: Herbert
authors.initials: H
authors.lastname: Stepp
authors.forename: Jörg
authors.initials: J
authors.lastname: Schirra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic / Q000187:drug effects* / Q000528:radiation effects / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008652:Mesoporphyrins / Q000008:administration & dosage*; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000008:administration & dosage*; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D008652:Mesoporphyrins; D017319:Photosensitizing Agents; C072269:temoporfin
keywords: Cholangiocarcinoma; Fluorescence kinetics; Foscan(®) PDT; mTHPC