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Survival Difference in Patients with Photodynamic Therapy of Nonresectable Bile Duct Cancer Using Different Hematoporphyrins

2007; Elsevier BV; Volume: 65; Issue: 5 Linguagem: Inglês

10.1016/j.gie.2007.03.488

1097-6779

Alexander Dechêne, Philip Hilgard, E Maldonado-Lopez, Juergen F. Riemann, Guido Gerken, Thomas Zoepf,

Neonatal Health and Biochemistry

Introduction: Photodynamic therapy (PDT) has shown a significant survival benefit in non-resectable bile duct cancer. Two different hematoporphyrin derivatives (HPD) are to date in use as photosensitizers, namely Photofrin II (PF2) and Photosan-3 (PS3). Little is known about a potential difference in the clinical effectiveness. Therefore the aim of this study was to determine the efficacy of both HPDs in photodynamic therapy of advanced bile duct cancer. Methods: The study was conducted in two phases. In the first treatment period we used Photosan-3 (2 mg/kg b.w.) as photosensitizer, while in the second period Photofrin II was used. Both sensitizers were administered 48 hours before laser irradiation. Irradiation was performed with a 4 cm quartz fibre and a diode laser system (635 nm; 1, 1W, 220J/cm). All patients were provided with plastic stents in the treated areas. Light protection was disposed for 4-6 weeks. Results: 16 patients received PS3 (11m/5f, median age 67y), 13 patients received PF2 (11m/2f; median age 70y). There was no statistical significant difference in age, tumor stage, gender and number of PDT treatment sessions in both treatment groups. Median survival in the PS3-group was 690 days [448-931; 95% CI] in the PF2-group 494 days [84-903; 95% CI] with no significant difference (p = 0, 87). There was no substantial skin reaction observed. 23% of patients in the PF2-group and 26% of patients in the PS3-group developed considerable cholangitis despite periinterventional antibiotic prophylaxis. Conclusion: Photodynamic therapy has the potential to considerably prolong survival in non resectable bile duct cancer. This effect is not dependent on the on the type of the available hematoprohyrin photosensitizer. Further efforts should be undertaken to evaluate more effective photosensitizing agents.