Neoadjuvant Down-Sizing of Hilar Cholangiocarcinoma with Photodynamic Therapy--Long-Term Outcome of a Phase II Pilot Study

Andrej Wagner, Marcus Wiedmann, Andrea Tannapfel, Christian Mayr, Tobias Kiesslich, Gernot W Wolkersdörfer, Frieder Berr, Johann Hauss, Helmut Witzigmann, Andrej Wagner, Marcus Wiedmann, Andrea Tannapfel, Christian Mayr, Tobias Kiesslich, Gernot W Wolkersdörfer, Frieder Berr, Johann Hauss, Helmut Witzigmann

Abstract

Hilar cholangiocarcinoma (CC) is non-resectable in the majority of patients often due to intrahepatic extension along bile duct branches/segments, and even after complete resection (R0) recurrence can be as high as 70%. Photodynamic therapy (PDT) is an established palliative local tumor ablative treatment for non-resectable hilar CC. We report the long-term outcome of curative resection (R0) performed after neoadjuvant PDT for downsizing of tumor margins in seven patients (median age 59 years) with initially non-resectable hilar CC. Photofrin(®) was injected intravenously 24-48 h before laser light irradiation of the tumor stenoses and the adjacent bile duct segments. Major resective surgery was done with curative intention six weeks after PDT. All seven patients had been curatively (R0) resected and there were no undue early or late complications for the neoadjuvant PDT and surgery. Six of seven patients died from tumor recurrence at a median of 3.2 years after resection, the five-year survival rate was 43%. These results are comparable with published data for patients resected R0 without pre-treatment, indicating that neoadjuvant PDT is feasible and could improve overall survival of patients considered non-curatively resectable because of initial tumor extension in bile duct branches/segments--however, this concept needs to be validated in a larger trial.

Keywords: PDT; bile duct cancer; neoadjuvant therapy; sodium porfimer.

Figures

Figure 1
Figure 1
Kaplan-Meier estimation of patient survival: The survival curve of the patients resected R0 after neoadjuvant PDT (n = 7) compared with the survival curve reported for the historical cohort of patients (n = 35) resected R0 without pre-treatment ([20], p = 0.34, log rank test). Individual patients still alive during follow-up are indicated by marks on the curves. Reprinted by permission of Wolters Kluwer Health [20]—promotional and commercial use of the material in print, digital or mobile device format is prohibited without the permission from the publisher Wolters Kluwer Health.

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