Photodynamic therapy of nonresectable cholangiocarcinoma

Ortner, Maria-Anna; Liebetruth, J; Schreiber, Stefan; Hanft, Marco; Wruck, U.; Fusco, Virginia; Müller, J. M.; Hörtnagl, Heide; Lochs, Herbert

doi:10.1016/s0016-5085(98)70537-2

Cited by 265 publications

(175 citation statements)

References 47 publications

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“…10 -13 In some studies, PDT has been used in the palliative management of hilar CCs. 14,15 These authors reported that the median survival time of patients was prolonged compared with other published reports and that patients' perception of their quality of life increased dramatically. In a single case, neoadjuvant PDT for hilar CC showed efficacious tumor destruction confined to the superficial 4 mm depth of the bile duct tumor and high tumor selectivity in the resected bile duct specimen.…”

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Neoadjuvant photodynamic therapy as a new approach to treating hilar cholangiocarcinoma

Wiedmann

Caca

Berr

et al. 2003

Cancer

161

105

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BACKGROUNDOnly 20–30% of patients with hilar cholangiocarcinomas (CC) are candidates for potentially curative resection. However, even after curative (R0) resection, these patients have a disease recurrence rate of up to 76%. The current prospective Phase II study investigated photodynamic therapy (PDT) as a neoadjuvant treatment for CC.METHODSSeven patients with advanced proximal bile duct carcinoma were evaluated. Patients were treated with PDT at the area of tumor infiltration and 2 cm beyond and underwent surgery after a median period of 6 weeks (range, 3–44 weeks).RESULTSOne patient had a Bismuth–Corlette Type II tumor, two patients had Type IIIa, one patient had Type IIIb, and three patients had Type IV. Cholestasis parameters after PDT decreased significantly. No relevant adverse events from PDT occurred except for minor intraoperative phototoxicity in one patient. Three patients underwent right‐sided liver resections, two patients underwent left‐sided liver resections, and one patient received a combined hilar resection with partial pancreatoduodenectomy (PD) due to tumor extension into the distal bile duct. Liver transplantation and PD were performed in another patient. In all patients, R0 resection was achieved. Four patients developed minor surgical complications, even though the bilioenteric anastomoses were sewn to PDT‐pretreated bile ducts. No viable tumor cells were found in the inner 4 mm layer of the surgical specimens. The PDT‐pretreated epithelium of the tumor‐free proximal resection margins exhibited only minimal inflammatory infiltration. Tumors recurred in 2 patients 6 and 19 months after surgery. The 1‐year recurrence free survival rate was 83%.CONCLUSIONSNeoadjuvant PDT for hilar CC is a low‐risk procedure with efficient selective destruction of the superficial 4 mm layer of bile duct tumor without complications exceeding series without neoadjuvant PDT. Neoadjuvant PDT should be evaluated prospectively to determine whether it reduces the rate of local disease recurrence after potentially curative resection. Cancer 2003;97:2783–90. © 2003 American Cancer Society.DOI 10.1002/cncr.11401

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confidence: 95%

Neoadjuvant photodynamic therapy as a new approach to treating hilar cholangiocarcinoma

Wiedmann

Caca

Berr

et al. 2003

Cancer

161

105

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“…In this setting, other treatment modalities, such as photodynamic therapy, have yielded preliminary beneficial results only for patients with ECC due to locoregional tumour control but not for those with metastatic disease (Ortner et al, 1998). A survival benefit of photodynamic therapy over best supportive care has only been demonstrated for patients not amenable to conventional stenting procedures (Ortner et al, 2003); therefore, its value relative to conventional stenting procedures remains unclear.…”

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Capecitabine plus oxaliplatin as first-line treatment in patients with advanced biliary system adenocarcinoma: a prospective multicentre phase II trial

et al. 2008

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This prospective multicentre phase II study characterises the toxicity and activity of first-line capecitabine and oxaliplatin combination therapy (CAPOX) in advanced biliary system adenocarcinomas. Patients received oxaliplatin (130 mg m À2 , day 1) plus capecitabine (1000 mg m À2 b.i.d., days 1 -14) every 3 weeks. Patients were stratified prospectively into two groups based on location of the primary (gallbladder carcinoma (GBC) or extrahepatic cholangiocarcinoma (ECC) versus intrahepatic mass-forming type cholangiocarcinoma (ICC)). Sixty-five patients were evaluable. The response rate in 47 patients with GBC/ECC was 27% (4% complete responses), and in 23 patients (49%) stable disease (SD) was encountered. In 18 patients with ICC, we observed no objective responses, but 6 patients (33%) had SD. Median survival was 12.8 months (95% CI, 10.0 -15.6) for patients with GBC or ECC (GBC: 8.2 months; 95% CI, 4.3 -11.7; ECC: 16.8 months; 95% CI, 12.7 -20.5), and 5.2 months (95% CI, 0.6 -9.8) for ICC patients. In both cohorts, therapy was well tolerated. The most common grade 3 -4 toxicity was peripheral sensory neuropathy (11 patients). Our data suggest that the CAPOX regimen is a well-tolerated and active treatment option for advanced ECC and GBC but might produce poorer results for ICC.

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“…30 Pilot data published while this study was in progress indicates that endoscopic PDT of bile duct cancer is feasible. 31,32 The rationale of this prospective phase-II trial was to investigate whether PDT increases the rate of survival after 6 months with acceptable quality of life and when it can keep the bile ducts patent with a low rate of adverse events.…”

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Photodynamic therapy for advanced bile duct cancer: Evidence for improved palliation and extended survival

et al. 2000

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Median survival time of nonresectable hilar bile duct cancer is only 4 to 6 months owing to tumor spread in the biliary tree, refractory cholestasis, and sepsis or liver failure. We explored whether local photodynamic therapy of nonresectable bile duct cancer could improve survival. A sample size of 23 patients is required to detect an increase in 6-month survival rate from less than 50% to greater than 70% in a single-arm phase-II trial with a statistical power of 80% (Fleming's single step procedure; ␣ ‫؍‬ 0.05). Twentythree consecutive patients (8 women, 15 men; 67 ؎ 14 years) with nonresectable bile duct cancer (Bismuth type III n ‫؍‬ 2, type IV n ‫؍‬ 21) were treated with photodynamic therapy and biliary endoprosthesis. Photofrin (QLT Pharmaceuticals, Vancouver, Canada) (2 mg/kg body weight intravenously) was photoactivated after 1 to 4 days with laser light (630 nm; 242 J/cm 2 ) via endoscopic retrograde access. The 6-month survival rate was 91% after diagnosis and 74% after start of photodynamic therapy (30-day mortality rate was 4%) at a median follow-up time of 10.3 months after diagnosis. Causes of death were tumor progression (n ‫؍‬ 9) and bacterial infections (n ‫؍‬ 4). The median rate of local tumor response was 74%, 54%, 29%, and 67% after the first, second, third, fourth, and fifth photodynamic therapy. Time to progression ranged from 3 to 8 months. All patients, except 1 with diffuse liver metastases, improved in cholestasis, performance, and quality of life. Photodynamic therapy can prevent tumor occlusion of hilar bile ducts. The apparent benefit in survival time should be confirmed in a controlled trial versus palliation by endoprosthesis only. (HEPATOLOGY 2000;31:291-298.)Hilar bile duct cancer is fraught with a very poor prognosis. 1,2 Tumors limited to the common bile duct, the bifurcation, or the bifurcation and the intrahepatic ducts of either the right or left lobe, types I, II, IIIa, and IIIb according to Bismuth, 3 may be curatively resectable with a 5-year survival rate of 9% to 21%, 4-8 and 26% to 30% in selected series. 9,10

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Photodynamic therapy of nonresectable cholangiocarcinoma

Cited by 265 publications

References 47 publications

Neoadjuvant photodynamic therapy as a new approach to treating hilar cholangiocarcinoma

Neoadjuvant photodynamic therapy as a new approach to treating hilar cholangiocarcinoma

Capecitabine plus oxaliplatin as first-line treatment in patients with advanced biliary system adenocarcinoma: a prospective multicentre phase II trial

Photodynamic therapy for advanced bile duct cancer: Evidence for improved palliation and extended survival

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