Adjuvant photodynamic therapy for bile duct carcinoma after surgery: a preliminary study

Atsushi Nanashima1 , Hiroyuki Yamaguchi1, Shinichi Shibasaki1, Noboru Ide1, Terumitsu Sawai1, Takashi Tsuji1, Shigekazu Hidaka1, Yorihisa Sumida1, Tohru Nakagoe1 and Takeshi Nagayasu1

(1) Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan

Received: 02 February 2004 Accepted: 21 April 2004

Abstract
Background Photodynamic therapy (PDT) is a new palliative option in patients with non-resectable bile duct carcinoma (BDC). Here, we assessed the efficacy of adjuvant photodynamic therapy in eight patients with BDC who underwent surgical resection.
Methods Five patients had extrahepatic BDC, two had intrahepatic cholangiocarcinoma, and one had ampullary carcinoma. Cancer cells were microscopically detected in the stump of the hepatic duct in six patients, and biliary stenosis caused by remnant tumor was observed in one patient. One patient had tumor recurrence with occlusion of the bile duct. At 48h prior to PDT, porfimer sodium was injected intravenously. A pulse laser by an eximer dye laser (50–100J/cm2) with a wavelength of 630µm was applied through an endoscope to the hepatic stump or tumor lesion.
Results Marked destruction of the tumor and ductal epithelium was observed on day 1 after PDT. After PDT, four patients developed mild dermatitis, but no severe morbidity or mortality was noted. In patients who underwent PDT for the stump, one patient showed distant metastasis at 31 months, and four patients did not show tumor recurrence at 17, 12, 12, and 6 months, respectively. However, one of the eight patients died at 2 months, of an unrelated cause. In two patients with occlusion caused by tumor growth, resolution of bile duct stenosis was noted on day 7. These patients showed re-occlusion by tumor at 20 and 8 months.
Conclusions Adjuvant PDT is a safe and useful option for a better survival benefit in patients with BDC undergoing surgical resection.
Key words photodynamic therapy - porfimer sodium - eximer dye laser - bile duct carcinoma - adjuvant treatment


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