Clin Endosc.  2013 Jan;46(1):38-44. 10.5946/ce.2013.46.1.38.

Current Status of Photodynamic Therapy for Bile Duct Cancer

Affiliations
  • 1Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea. yksky001@hanmail.net

Abstract

The most common form in bile duct cancers is a highly desmoplastic cancer with a growth pattern characterized by periductal extension and infiltration. The prognosis of bile duct cancers, especially hilar cholangiocarcinoma, is limited by tumor spread along the biliary tree leading to refractory obstructive cholestasis, cholangitis, and liver failure. Although biliary endoprosthesis improves occlusion rates and reduces the number of therapeutic interventions, median survival time is not ameliorated. Photodynamic therapy (PDT) is a local photochemical tumor treatment that consists of a photosensitizing agent in combination with laser irradiation of a distinct wavelength. Tumor ablation with PDT combined with biliary stenting reduces cholestasis and significantly improves median survival time in selected patients with bile duct cancers.

Keyword

Cholangiocarcinoma; Bile duct neoplasms; Endoprosthesis; Photodynamic therapy; Photosensitizing agents

MeSH Terms

Bile
Bile Duct Neoplasms
Bile Ducts
Biliary Tract
Cholangiocarcinoma
Cholangitis
Cholestasis
Humans
Liver Failure
Photochemotherapy
Photosensitizing Agents
Prognosis
Stents
Triazenes
Photosensitizing Agents
Triazenes

Figure

  • Fig. 1 A sclerosing type of bile duct cancer. A cholangioscopy shows the luminal narrowing with a whitish mucosal discoloration and neovascularization.

  • Fig. 2 A papillary type of bile duct cancer. A cholangioscopy shows that slight papillary and mucosal nodularity is seen in the intrahepatic bile duct. In this type of tumor, the mucosal lesion may be minute and detectable only by careful cholangioscopic examination of the entire biliary tree.

  • Fig. 3 A nodular or polypoid type of bile duct cancer. A polypoid mass partially obstructs the lumen of the common hepatic duct. Mucosal irregularity and intense serpiginous neovascularization are clearly visible on the surface.

  • Fig. 4 Photodynamic therapy (PDT) for postoperative recurrent tumor. A 76-year-old man was referred to our hospital with jaundice. He received Whipple's operation due to hilar cholangiocarcinoma 1 year ago. (A) Magnetic resonance imaging shows a contrast enhanced hilar mass with obstructing anastomosis site. (B) Cholangioscopy shows mucosal nodularity and neovascularization in the anastomosis site. Biopsy specimens revealed adenocarcinoma. (C) Two days after PDT. Cholangiocopy shows circumferential coagulation necrosis at the PDT-treated lesion. (D) One year after the PDT, recanalized anastomotic site and small papillary changes with no abnormal vessels can be seen on cholangioscopy. Cholangioscopic biopsy specimens revealed chronic nonspecific inflammation.


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