PHOTODYNAMIC THERAPY OF NONRESECTABLE CHOLANGIOCARCINOMA

Background & Aims: Successful treatment in nonresectable Bismuth type III and IV cholangiocarcinoma is seldom achieved, The aim of this stud y was to evaluate the effect of photodynamic therapy on cholestasis, q uality of life, and survival in these patients. Methods: Nine patients with advanced nonresectable cholangiocarcinomas Bismuth type III and IV, who showed no sufficient drainage (bilirubin decrease <50%) after endoscopic stent insertion, underwent photodynamic therapy. Two days a fter intravenous application of a hematoporphyrin derivate, intralumin al photoactivation was performed cholangioscopically. Serum bilirubin, quality of life, and survival time were assessed in two monthly inter vals after photodynamic therapy. Results: After photodynamic therapy, bilirubin serum levels declined from 318 +/- 72 to 103 +/- 35 mu mol/L (P = 0.0039) with no significant increase during the two monthly foll ow-ups. Quality of life indices improved dramatically and remained sta ble (e.g. Karnofsky index from 32.2% +/- 8.13% to 68.9% +/- 6.1%; P = 0.0078). Thirty-day mortality was 0%, and median survival time was 439 days. Conclusions: This study provides clear evidence that photodynam ic therapy is effective in restoring biliary drainage and improving qu ality of life in patients with nonresectable disseminated cholangiocar cinomas Bismuth type III and IV. Compared with published data, surviva l time seems to be prolonged.