Gut and Liver

Indexed in MEDLINE, PubMed / PubMed central, Science Citation Index Expanded (SCIE),
ElsevierBibliographic Databases (Scopus & Embase), Google Scholar, KoreaMed

Photodynamic Therapy for Cholangiocarcinoma

Jayant P. Talreja and Michel Kahaleh
Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cholangiocarcinoma is the primary malignancy arising from the biliary epithelium, and it presents as jaundice, cholestasis, and cholangitis. Over 50 percent of patients present with advanced-stage disease, and the prognosis is poor with the survival measured in months even after biliary decompression. Palliative management has become the standard of care for unresectable disease, and this involves an endoscopic approach. Photodynamic therapy (PDT) involves the administration of a photosensitizer followed by local irradiation with laser therapy. The use of PDT for palliation of bile-duct tumors has produced promising results. Several studies conducted in Europe and the United States have shown that PDT produces a marked improvement in the symptoms of cholestasis, survival, and quality of life. This chapter summarizes the principle of PDT, the technique employed, and the published experience regarding PDT for cholangiocarcinoma.
Cholangiocarcinoma; Photodynamic therapy; Biliary cancer
1. Ahrendt SA, Nakeeb A, Pitt HA. Cholangiocarcinoma. Clin Liver Dis 2001;5:191-218.
2. Bergquist A, Ekbom A, Olsson R, et al. Hepatic and extrahepatic malignancies in primary sclerosing cholangitis. J Hepatol 2002;36:321-327.
3. Haswell-Elkins MR, Mairiang E, Mairiang P, et al. Crosssectional study of Opisthorchis viverrini infection and cholangiocarcinoma in communities within a high-risk area in northeast Thailand. Int J Cancer 1994;59:505-509.
4. Jang KT, Hong SM, Lee KT, et al. Intraductal papillary neoplasm of the bile duct associated with Clonorchis sinensis infection. Virchows Arch 2008;453:589-598.
5. Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD. Cholangiocarcinoma. Lancet 2005;366:1303-1314.
6. Kim YT, Byun JS, Kim J, et al. Factors predicting concurrent cholangiocarcinomas associated with hepatolithiasis. Hepatogastroenterology 2003;50:8-12.
7. Kubo S, Kinoshita H, Hirohashi K, Hamba H. Hepatolithiasis associated with cholangiocarcinoma. World J Surg 1995;19:637-641.
8. Lesurtel M, Regimbeau JM, Farges O, Colombat M, Sauvanet A, Belghiti J. Intrahepatic cholangiocarcinoma and hepatolithiasis: an unusual association in Western countries. Eur J Gastroenterol Hepatol 2002;14:1025-1027.
9. Rubel LR, Ishak KG. Thorotrast-associated cholangiocarcinoma: an epidemiologic and clinicopathologic study. Cancer 1982;50:1408-1415.
10. Anderson CD, Pinson CW, Berlin J, Chari RS. Diagnosis and treatment of cholangiocarcinoma. Oncologist 2004;9: 43-57.
11. Gao F, Bai Y, Ma SR, Liu F, Li ZS. Systematic review: photodynamic therapy for unresectable cholangiocarcinoma. J Hepatobiliary Pancreat Sci 2010;17:125-131.
12. Jarnagin WR, Shoup M. Surgical management of cholangiocarcinoma. Semin Liver Dis 2004;24:189-199.
13. Lazaridis KN, Gores GJ. Cholangiocarcinoma. Gastroenterology 2005;128:1655-1667.
14. Neuhaus P, Jonas S, Bechstein WO, et al. Extended resections for hilar cholangiocarcinoma. Ann Surg 1999; 230:808-818.
15. Wiedmann M, Berr F, Schiefke I, et al. Photodynamic therapy in patients with non-resectable hilar cholangiocarcinoma: 5-year follow-up of a prospective phase II study. Gastrointest Endosc 2004;60:68-75.
16. Chaudhary A, Dhar P, Tomey S, Sachdev A, Agarwal A. Segment III cholangiojejunostomy for carcinoma of the gallbladder. World J Surg 1997;21:866-870.
17. Havlik R, Sbisa E, Tullo A, et al. Results of resection for hilar cholangiocarcinoma with analysis of prognostic factors. Hepatogastroenterology 2000;47:927-931.
18. Kapoor VK, Pradeep R, Haribhakti SP, et al. Intrahepatic segment III cholangiojejunostomy in advanced carcinoma of the gallbladder. Br J Surg 1996;83:1709-1711.
19. Lai EC, Tompkins RK, Mann LL, Roslyn JJ. Proximal bile duct cancer. Quality of survival. Ann Surg 1987;205:111- 118.
20. Blom D, Schwartz SI. Surgical treatment and outcomes in carcinoma of the extrahepatic bile ducts: the University of Rochester experience. Arch Surg 2001;136:209-215.
21. Figueras J, Llado L, Valls C, et al. Changing strategies in diagnosis and management of hilar cholangiocarcinoma. Liver Transpl 2000;6:786-794.
22. Baer HU, Stain SC, Dennison AR, Eggers B, Blumgart LH. Improvements in survival by aggressive resections of hilar cholangiocarcinoma. Ann Surg 1993;217:20-27.
23. van Groeningen CJ. Intravenous and intra-arterial chemotherapeutic possibilities in biliopancreatic cancer. Ann Oncol 1999;10 Suppl 4:305-307.
24. Ducreux M, Rougier P, Fandi A, et al. Effective treatment of advanced biliary tract carcinoma using 5-fluorouracil continuous infusion with cisplatin. Ann Oncol 1998;9: 653-656.
25. Choi CW, Choi IK, Seo JH, et al. Effects of 5-fluorouracil and leucovorin in the treatment of pancreatic-biliary tract adenocarcinomas. Am J Clin Oncol 2000;23:425-428.
26. Patt YZ, Jones DV Jr, Hoque A, et al. Phase II trial of intravenous flourouracil and subcutaneous interferon alfa-2b for biliary tract cancer. J Clin Oncol 1996;14:2311-2315.
27. Khan SA, Davidson BR, Goldin R, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document. Gut 2002;51 Suppl 6:VI1-VI9.
28. Ayaru L, Bown SG, Pereira SP. Photodynamic therapy for pancreatic and biliary tract carcinoma. Int J Gastrointest Cancer 2005;35:1-13.
29. Bowling TE, Galbraith SM, Hatfield AR, Solano J, Spittle
MF. A retrospective comparison of endoscopic stenting
alone with stenting and radiotherapy in non-resectable
cholangiocarcinoma. Gut 1996;39:852-855. 30. Thongprasert S. The role of chemotherapy in cholangiocarcinoma. Ann Oncol 2005;16 Suppl 2:ii93-ii96.
31. Baisden JM, Kahaleh M, Weiss GR, et al. Multimodality treatment with helical tomotherapy intensity modulated radiotherapy, capecitabine, and photodynamic therapy is feasible and well tolerated in patients with hilar cholangiocarcinoma. Gastrointest Cancer Res 2008;2:219-224.
32. Wiedmann M, Caca K, Berr F, et al. Neoadjuvant photodynamic therapy as a new approach to treating hilar cholangiocarcinoma: a phase II pilot study. Cancer 2003;97: 2783-2790.
33. Ortner ME, Caca K, Berr F, et al. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology 2003;125:1355- 1363.
34. Wong Kee Song LM, Wang KK, Zinsmeister AR. Mono- L-aspartyl chlorin e6 (NPe6) and hematoporphyrin derivative (HpD) in photodynamic therapy administered to a human cholangiocarcinoma model. Cancer 1998;82:421- 427.
35. Henderson BW, Waldow SM, Mang TS, Potter WR, Malone PB, Dougherty TJ. Tumor destruction and kinetics of tumor cell death in two experimental mouse tumors following photodynamic therapy. Cancer Res 1985;45:572- 576.
36. Berr F, Wiedmann M, Tannapfel A, et al. Photodynamic therapy for advanced bile duct cancer: evidence for improved palliation and extended survival. Hepatology 2000; 31:291-298.
37. Kahaleh M, Mishra R, Shami VM, et al. Unresectable cholangiocarcinoma: comparison of survival in biliary stenting alone versus stenting with photodynamic therapy. Clin Gastroenterol Hepatol 2008;6:290-297.
38. Zoepf T, Jakobs R, Arnold JC, Apel D, Riemann JF. Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy. Am J Gastroenterol 2005;100:2426-2430.
39. Vauthey JN, Blumgart LH. Recent advances in the management of cholangiocarcinomas. Semin Liver Dis 1994;14: 109-114.
40. Talreja JP, Degaetani M, Rehan ME, Sauer BG, Kahaleh M. T1521: single operator cholangioscopy for unresectable cholangiocarcinoma treated with photodynamic therapy: what are the benefits? Gastrointest Endosc 2010;71:AB299.
41. Ortner MA, Liebetruth J, Schreiber S, et al. Photodynamic therapy of nonresectable cholangiocarcinoma. Gastroenterology 1998;114:536-542.
42. Zoepf T. Photodynamic therapy of cholangiocarcinoma. HPB (Oxford) 2008;10:161-163.
43. Ibrahim T, Kahaleh M. Photodynamic therapy: palliation and endoscopic technique in cholangiocellular carcinoma. Interv Ther Gastrointest Endosc 2010;27:423-429.
44. Prasad GA, Wang KK, Baron TH, et al. Factors associated with increased survival after photodynamic therapy for cholangiocarcinoma. Clin Gastroenterol Hepatol 2007;5: 743-748.
45. Judah JR, Draganov PV. Intraductal biliary and pancreatic endoscopy: an expanding scope of possibility. World J Gastroenterol 2008;14:3129-3136.
46. Fishman DS, Tarnasky PR, Patel SN, Raijman I. Management of pancreaticobiliary disease using a new intra-ductal endoscope: the Texas experience. World J Gastroenterol 2009;15:1353-1358.
47. Baron TH. Photodynamic therapy: standard of care for palliation of cholangiocarcinoma? Clin Gastroenterol Hepatol 2008;6:266-267.
48. Rumalla A, Baron TH, Wang KK, Gores GJ, Stadheim LM, de Groen PC. Endoscopic application of photodynamic therapy for cholangiocarcinoma. Gastrointest Endosc 2001; 53:500-504.
49. Dumoulin FL, Gerhardt T, Fuchs S, et al. Phase II study of photodynamic therapy and metal stent as palliative treatment for nonresectable hilar cholangiocarcinoma. Gastrointest Endosc 2003;57:860-867.
50. Harewood GC, Baron TH, Rumalla A, et al. Pilot study to assess patient outcomes following endoscopic application of photodynamic therapy for advanced cholangiocarcinoma. J Gastroenterol Hepatol 2005;20:415-420.
51. Witzigmann H, Berr F, Ringel U, et al. Surgical and palliative management and outcome in 184 patients with hilar cholangiocarcinoma: palliative photodynamic therapy plus stenting is comparable to r1/r2 resection. Ann Surg 2006; 244:230-239.
Gut and Liver 2010 Sep; 4(0): 62-66
Submit a manuscript
Sign up for article alerts
Log in