Clinical

Palliative photodynamic therapy improves survival in bile duct cancer

Last Updated: 2005-12-23 7:30:11 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In patients with nonresectable bile duct cancer, photodynamic therapy (PDT) designed to reduce bile duct stenosis improves quality of life and substantially prolongs survival time, physicians in Germany report.

Preliminary uncontrolled studies of photodynamic therapy have demonstrated "astonishingly good results," Dr. Thomas Zoepf and his associates note in their paper in the American Journal of Gastroenterology for November.

Dr. Zoepf, from University Hospital Essen, and his team conducted a prospective trial in which patients with advanced nonresectable bile duct cancer were randomly assigned to an endoprosthesis alone or an endoprosthesis plus PDT (16 patients in each group).

PDT involved IV administration of the hematoporphyrin derivative Photosan 3 (SeeLab, Wesselburenerkoog, Germany), followed 2 days later with laser irradiation administered either through transpapillary access or percutaneously.

"Four weeks after initial PDT, most PDT-patients showed an almost complete elimination of bile duct stenosis in the treated area as demonstrated by cholangiography," the authors report.

Median survival was 21 months in the PDT group versus 7 months in the control group (p = 0.01). The investigators also note that among the eight patients in the PDT group who initially required percutaneous transhepatic drainage, four could be converted to transpapillary access, representing a "significant improvement in the quality of life."

There were four serious infections in the PDT group as opposed to one in the control group. However, these occurred in the early phase of the study when only 3 days of antibiotics was given; there were no more serious infections once coverage was increased to 14 days.

Dr. Zoepf's group recommends larger clinical trials to confirm their results. Moreover, they add, "as hematoporphyrins also have radiosensitizing properties, a combination of PDT and radiotherapy may further improve tumor response and survival time in future."

Am J Gastroenterol 2005;100:2426-2430.