A recent study indicates that the combination of photodynamic therapy (PDT) and endoscopic retrograde cholangiopancreatiography (ERCP) may improve survival for patients with bile duct cancer. These findings were published in Clinical Gastroenterology and Hepatology.
Cancer of the bile duct is a rare disease in which cancerous cells form in the bile ducts, located outside of the liver. Bile ducts are a network of tubes that connect the liver and the gallbladder to the small intestine. This network allows bile, a digestive fluid made by the liver, to be passed from the liver to the small intestine where fats are broken down during digestion. Prognosis for bile duct cancer depends on several factors including whether or not the cancer has spread to other parts of the body, whether the tumor can be removed by surgery, and the location of the cancer within the duct. Treatment options may include surgery, chemotherapy, radiation, or biological therapy.
Unfortunately, bile duct cancer is rarely found before it has spread to other areas, and complete surgical removal is often not possible. In this case palliative treatments may help relieve the patient’s symptoms and improve their quality of life.
One palliative approach may include ERCP, a procedure that involves inserting a stent in the clogged bile ducts to allow normal function to resume. Another option may include PDT, where CT scans are utilized to insert laser fibers into the tumor. These laser fibers destroy the tumor by burning it with a light. Previous research has shown that PDT is associated with improved quality of life and potentially, survival.
In the current study, researchers evaluated the combination of ERCP and PDT for the treatment of patients with bile duct cancer who were not candidates for surgery. The goal of the study was to determine if the combination would improve overall survival. Researchers evaluated 48 patients during a five-year period. Nineteen were treated with PDT and ERCP, and 29 were treated with ERCP alone. Analysis included additional factors such as stage of cancer, age, treatment with chemotherapy or radiation, as well as the number of ERCP and PDT procedures each patient underwent. .
- The combination of ERCP and PDT improved survival when compared with ERCP only.
- Death rates occurring in the PDT/ERCP group at three, six and twelve months were 0%, 16%, and 56%, respectively, compared with 28%, 52%, and 82% among patients treated with ERCP alone.
- Side effects occurred only in PDT patients and included skin toxicities, which were treated topically.
Researchers concluded that ERCP with PDT improved survival compared with ERCP alone in patients who are not candidates for surgery. Future research would help determine if this benefit was the result of the addition of PDT or the number of ERCP procedures.
Reference: Kahaleh, M., Mishra, R., Shami, VM., et al. Unresectable cholangiocarcinoma: comparison of survival in biliary stenting alone versus stenting with photodynamic therapy. Clinical Gastroenterology and Hepatology [published online]. 2008 Mar; 6(3):290-7. Feb 6, 2008.