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Biliary drainage, photodynamic therapy and chemotherapy for unresectable cholangiocarcinoma with jaundice
Author(s) -
Fuks David,
Bartoli Eric,
Delcenserie Richard,
Yzet Thierry,
Celice Pierre,
Sabbagh Charles,
Chatelain Denis,
Joly JeanPaul,
Cheron Nathalie,
Dupas JeanLouis,
Regimbeau JeanMarc
Publication year - 2009
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2009.05915.x
Subject(s) - medicine , photodynamic therapy , concomitant , jaundice , chemotherapy , gemcitabine , gastroenterology , surgery , chemistry , organic chemistry
Background and Aim: The combination of photodynamic therapy and biliary stenting seems to be beneficial in the palliative treatment of unresectable cholangiocarcinoma. We aimed to assess the accuracy of photodynamic therapy in a single centre. Methods: Fourteen selected patients, with jaundice related to unresectable cholangiocarcinoma, underwent photodynamic therapy and biliary stenting (with or without chemotherapy). Photofrin was injected intravenously (2 mg/kg) 2 days before intraluminal photoactivation. In case of malignant progression, photodynamic therapy was repeated. The outcome parameters were overall survival and quality of life. Results: There were eight men and six women (median age: 67 [42–81]). Unresectability was related to a low Karnofski index ( n = 2), peritoneal carcinomatosis ( n = 4), vascular involvement ( n = 3), invasion of the hepatoduodenal ligament ( n = 2) and an under‐sized liver remnant ( n = 3). Biliary stenting was efficient (≥ 50% total bilirubin) in 78.5% of cases. Eight patients developed cholangitis. The mean number of photodynamic therapy procedures was two (1–4). Six (43%) patients needed ≥ 2 procedures. No severe toxicity was noted. Photodynamic therapy improved the Karnofski index in 64% of cases. Six (42.8%) patients received concomitant chemotherapy (gemcitabine). The median survival time was 13.8 [0.7–29.2] months. The 3‐, 6‐ and 12‐month survival rates were 85%, 77% and 77%, respectively. Conclusion: These results confirm the beneficial effect of biliary drainage, photodynamic therapy and chemotherapy for unresectable cholangiocarcinoma in selected patients with jaundice.