Pilot study to assess patient outcomes following endoscopic application of photodynamic therapy for advanced cholangiocarcinoma

Gavin C. Harewood, Todd H. Baron, Ashwin Rumalla, Kenneth Ke Ning Wang, Gregory James Gores, Linda M. Stadheim, Piet C. De Groen

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Background: Photodynamic therapy (PDT) has demonstrated promise in the palliative treatment of advanced cholangiocarcinoma. The aim of this pilot study was to assess the outcome in patients with non-resectable cholangiocarcinoma following endoscopic application of PDT directly into the biliary tract. Methods: In patients with advanced cholangiocarcinoma, endoscopic retrograde cholangiopancreatography (ERCP) was performed to define the proximal and distal extent of intraductal tumor. Sodium porfimer was administered intravenously to all patients. Forty-eight hours later, a commercially available cylindrical diffusing laser fiber (1-2.5 cm in length, OptiGuide) designed for esophageal use was advanced across the biliary strictures. Laser light was applied at a power of 400 mW/cm fiber for a total energy of 180 J/cm2 using an argon-pumped tunable dye laser. Patients received endoscopic PDT every 3 months provided they maintained a favorable performance status. Plastic biliary stents were replaced immediately following light application and were maintained in all patients. Results: Using a preloaded catheter, adequate positioning of the laser fiber was achieved in all patients. Eight patients with advanced cholangiocarcinoma received a total of 19 PDT treatments, range 1-5 treatments/patient. All eight patients were followed until death; mean follow-up was 9.8 months. Median survival from the date of the first PDT treatment was 276 days, which compares favorably with published series that have reported median survival times between 45 and 127 days for patients with bismuth type III and IV tumors treated with stenting alone. Conclusions: Endoscopic application of PDT demonstrates promise in prolonging survival in patients with advanced cholangiocarcinoma. Additional randomized clinical trials using commercially available fibers are needed to fully evaluate both the optimum frequency and treatment interval of endoscopic PDT in the management of advanced cholangiocarcinoma.

Original languageEnglish (US)
Pages (from-to)415-420
Number of pages6
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume20
Issue number3
DOIs
StatePublished - 2005

Fingerprint

Cholangiocarcinoma
Photochemotherapy
Lasers
Survival
Dihematoporphyrin Ether
Dye Lasers
Light
Bismuth
Argon
Endoscopic Retrograde Cholangiopancreatography
Biliary Tract
Therapeutics
Palliative Care
Plastics
Stents
Neoplasms
Pathologic Constriction
Catheters
Randomized Controlled Trials

Keywords

  • Cholangiocarcinoma
  • Endoscopy
  • Photodynamic therapy

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Pilot study to assess patient outcomes following endoscopic application of photodynamic therapy for advanced cholangiocarcinoma. / Harewood, Gavin C.; Baron, Todd H.; Rumalla, Ashwin; Wang, Kenneth Ke Ning; Gores, Gregory James; Stadheim, Linda M.; De Groen, Piet C.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 20, No. 3, 2005, p. 415-420.

Research output: Contribution to journalArticle

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