Endoscopy 2019; 51(04): S38
DOI: 10.1055/s-0039-1681281
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: ERCP stenosis Club H
Georg Thieme Verlag KG Stuttgart · New York

PHOTODYNAMIC THERAPY IN THE TREATMENT OF LARGE DUODENAL PAPILLA AND EXTRAHEPATIC BILE DUCTS CANCER

E Stranadko
1   State Research Center for Laser Medicine of FMBA, Moscow, Russian Federation
,
A Lobakov
2   Moscow Regional Research and Clinical Institute (MONIKI), Moscow, Russian Federation
,
V Morokhotov
2   Moscow Regional Research and Clinical Institute (MONIKI), Moscow, Russian Federation
,
M Riabov
1   State Research Center for Laser Medicine of FMBA, Moscow, Russian Federation
,
V Duvansky
1   State Research Center for Laser Medicine of FMBA, Moscow, Russian Federation
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Cancers of Vater's papilla and extrahepatic bile ducts are hardly accessible tumor localizations characterized by extensive tumor growth and poor prognosis. Surgical resection provides limited success with rather high recurrence rate. Photodynamic therapy (PDT) is a new technique, providing both, adequate tumor destruction and minimal damage to surrounding tissue.

The aim of this study was the development of PDT technique for the treatment of both Vater's papilla and extrahepatic bile duct cancer in inoperable patients for improvement of their quality of life and increase of their survival time.

Methods:

PDT has been performed in 29 patients. The average age was 68.5 years. Cancer of Vater's papilla was diagnosed in 20 patients, cancer of the common bile duct in 3 patients, cancer of the liver port in 1 patient, and cancer of the gall bladder in 4 patients. Photoditazine (a chlorin-e6 derivative) was used as photosensitizer, diode laser was used for irradiation via either endoscopic or transhepatic route. Patients were divided into several groups. Outcomes were assessed by determining the median survival.

Results:

The treatment was well-tolerated by the patients. The median survival time was 18 months (minimum -11 months, maximum – 24 months. There were no lethal outcomes. In patients who had only one PDT session during the year, the median survival was 12.5 months; in patients who had two or more PDT sessions, the median survival was 23 months.

Conclusions:

Results of PDT treatment for cancer of this localization are quite comparable with the results of radical surgeries and are better than palliative surgeries.

Decrease of tumor growth rate and longer survival period in patients with residual tumor after PDT treatment are determined by vascular mechanisms produced by PDT which lead to vascular thrombosis and impaired tumor blood supply, these factors provide long-term process stabilization. Repeated PDT courses significantly improve treatment results.