PHOTODYNAMIC THERAPY FOR MALIGNANT-TUMORS OF THE AMPULLA OF VATER

Ten patients with ampullary carcinoma, not suitable for surgery, were treated with endoscopic photodynamic therapy (PDT) to evaluate the fea sibility and safety of treatment. Patients received 4 mg kg(-1) of hae matoporphyrin derivative intravenously. Two days later, a duodenoscopy was performed and red (630 nm) light delivered to the tumour at fixed energy densities of 50 J or 200 J cm(-1) per application, depending o n the type of optical fibre used. The tumours were treated by three or four light applications at each session. Treatment was repeated up to five times at intervals of three to six months. The sole complication of PDT was moderate skin photosensitivity, which occurred in three pa tients. Tumour size was assessed at four to eight weekly intervals. In the absence of macroscopic tumour, biopsy specimens were taken. In th ree patients with small tumours confined to the ampulla, remission was obtained for periods ranging from eight to 12 months. In a further fo ur patients with small tumours bulk was greatly reduced. There was Lit tle response in three patients with extensive duodenal involvement. Th erefore PDT for ampullary carcinoma is bath feasible and safe, and wit h refinement may prove curative for small tumours.