Photodynamic Therapy in Proximal Bile Duct Cancer

Photodynamic Therapy in Proximal Bile Duct Cancer On initial diagnosis, hilar bile duct cancer no longer is curatively resectable in the majority of patients. When comparing palliative treatment modalities, photodynamic therapy (PDT) using the photosensitizer porfimer and elective exchange of biliary endoprostheses every 3 months results in the longest survival times. However, porfimer PDT does not achieve complete eradication of the primary tumor, due to its low tumoricidal penetration depth of only 4 mm, and should therefore be rated as local palliative therapy (similar as biliary endoprostheses), but not as oncologic tumor therapy. Thus, the long survival with porfimer PDT shows the effect of optimized supportive treatment on survival time and reflects slow metastatic potential in most of these cases. Therefore, chemotherapy should be applied at first evidence of nodal or systemic progression. Combination of PDT with radiochemotherapy or chemotherapy is tolerable and beneficial for patients with nodal / systemic progression in whom no bile duct segments are blocked or destroyed by bacterial cholangitis. Temoporfin-PDT shows higher tumoricidal penetration with comparable side effects as porfimer-PDT and a trend for longer time until local progression and longer survival time.