Photodynamic therapy for palliation of nonresectable bile duct cancer - Preliminary results with a new diode laser system

OBJECTIVES: Preliminary results of photodynamic therapy (PDT) of bile duct cancer have shown astonishingly good results in the reduction of cholestasi s, improvement of quality of life, and even prolongation of the survival ti me. Unfortunately, the existing dye laser systems are large and costly, and their maintenance is expensive. Therefore, we investigated the feasibility of a diode laser system for PDT of nonresectable bile duct cancer. METHODS: Eight patients with nonresectable bile duct cancer were treated. F orty-eight hours after i.v. application of 2 mg/kg body weight of Photosan- 3, light activation was performed by a transpapillary (four patients) or pe rcutaneous (four patients) access. We used a cylindrical diffuser tip and i lluminated using a wavelength of 633 +/- 3 nm and a total energy of 200 J/c m(2). All patients were additionally provided with bile duct endoprostheses after PDT. RESULTS: Four weeks after initial PDT all patients showed a marked reductio n of bile duct stenosis. The median serum bilirubin value declined from 5.8 mg/dl (2.0-10.1) to 1.0 mg/dl (0.8-4.4). The median survival time at the t ime of writing is 119 days (52-443). Five patients are still alive. In four patients we could change from percutaneous to transpapillary drainage afte r PDT, two patients showed infectious complications. CONCLUSION: PDT with the diode laser system seems to be effective in reduci ng malignant bile duct stenosis. This treatment is minimally invasive and h as a low specific complication rate. Randomized, controlled studies compari ng PDT with the insertion of endoprostheses and long term follow-up of resu lts are needed to confirm the promising short term results.