title: Neoadjuvant Down-Sizing of Hilar Cholangiocarcinoma with Photodynamic Therapy--Long-Term Outcome of a Phase II Pilot Study.
abstract: Hilar cholangiocarcinoma (CC) is non-resectable in the majority of patients often due to intrahepatic extension along bile duct branches/segments, and even after complete resection (R0) recurrence can be as high as 70%. Photodynamic therapy (PDT) is an established palliative local tumor ablative treatment for non-resectable hilar CC. We report the long-term outcome of curative resection (R0) performed after neoadjuvant PDT for downsizing of tumor margins in seven patients (median age 59 years) with initially non-resectable hilar CC. Photofrin(®) was injected intravenously 24-48 h before laser light irradiation of the tumor stenoses and the adjacent bile duct segments. Major resective surgery was done with curative intention six weeks after PDT. All seven patients had been curatively (R0) resected and there were no undue early or late complications for the neoadjuvant PDT and surgery. Six of seven patients died from tumor recurrence at a median of 3.2 years after resection, the five-year survival rate was 43%. These results are comparable with published data for patients resected R0 without pre-treatment, indicating that neoadjuvant PDT is feasible and could improve overall survival of patients considered non-curatively resectable because of initial tumor extension in bile duct branches/segments--however, this concept needs to be validated in a larger trial.
authors.affiliation: Department of Medicine I, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Muellner Hauptstrasse 48, 5020 Salzburg, Austria. and.wagner@salk.at.
authors.forename: Andrej
authors.initials: A
authors.lastname: Wagner
authors.affiliation: Department of Internal Medicine I, St. Mary's Hospital, Gallwitzallee 123-143, 12249 Berlin, Germany. wiedmann@marienkrankenhaus-berlin.de.
authors.forename: Marcus
authors.initials: M
authors.lastname: Wiedmann
authors.affiliation: Institute of Pathology, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany. andrea.tannapfel@rub.de.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tannapfel
authors.affiliation: Department of Medicine I, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Muellner Hauptstrasse 48, 5020 Salzburg, Austria. ch.mayr@salk.at.|Institute of Physiology and Pathophysiology, Paracelsus Medical University, Strubergasse 22, 5020 Salzburg, Austria. ch.mayr@salk.at.
authors.forename: Christian
authors.initials: C
authors.lastname: Mayr
authors.affiliation: Department of Medicine I, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Muellner Hauptstrasse 48, 5020 Salzburg, Austria. t.kiesslich@salk.at.|Institute of Physiology and Pathophysiology, Paracelsus Medical University, Strubergasse 22, 5020 Salzburg, Austria. t.kiesslich@salk.at.
authors.forename: Tobias
authors.initials: T
authors.lastname: Kiesslich
authors.affiliation: Department of Medicine I, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Muellner Hauptstrasse 48, 5020 Salzburg, Austria. g.wolkersdoerfer@salk.at.
authors.forename: Gernot W
authors.initials: GW
authors.lastname: Wolkersdörfer
authors.affiliation: Department of Medicine I, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Muellner Hauptstrasse 48, 5020 Salzburg, Austria. frieder.berr@pmu.ac.at.
authors.forename: Frieder
authors.initials: F
authors.lastname: Berr
authors.affiliation: Second Department of Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany. johann.hauss@uniklinik-leipzig.de.
authors.forename: Johann
authors.initials: J
authors.lastname: Hauss
authors.affiliation: Department for General and Visceral Surgery, Städtisches Krankenhaus Dresden-Friedrichstadt, Friedrichstraße 41, 01067 Dresden, Germany. helmut.witzigmann@khdf.de.
authors.forename: Helmut
authors.initials: H
authors.lastname: Witzigmann
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D017323:Dihematoporphyrin Ether / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D018285:Klatskin Tumor / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D010865:Pilot Projects; D012008:Recurrence; D016019:Survival Analysis
chemical_list: D017319:Photosensitizing Agents; D017323:Dihematoporphyrin Ether
keywords: PDT; bile duct cancer; neoadjuvant therapy; sodium porfimer