Wiedmann Marcus, Caca Karel, Berr Frieder, Schiefke Ingolf, Tannapfel Andrea, Wittekind Christian, Mössner Joachim, Hauss Johann, Witzigmann Helmut
Department of Internal Medicine II, University of Leipzig, Germany.
Cancer. 2003 Jun 1;97(11):2783-90. doi: 10.1002/cncr.11401.
Only 20-30% of patients with hilar cholangiocarcinomas (CC) are candidates for potentially curative resection. However, even after curative (R0) resection, these patients have a disease recurrence rate of up to 76%. The current prospective Phase II study investigated photodynamic therapy (PDT) as a neoadjuvant treatment for CC.
Seven patients with advanced proximal bile duct carcinoma were evaluated. Patients were treated with PDT at the area of tumor infiltration and 2 cm beyond and underwent surgery after a median period of 6 weeks (range, 3-44 weeks).
One patient had a Bismuth-Corlette Type II tumor, two patients had Type IIIa, one patient had Type IIIb, and three patients had Type IV. Cholestasis parameters after PDT decreased significantly. No relevant adverse events from PDT occurred except for minor intraoperative phototoxicity in one patient. Three patients underwent right-sided liver resections, two patients underwent left-sided liver resections, and one patient received a combined hilar resection with partial pancreatoduodenectomy (PD) due to tumor extension into the distal bile duct. Liver transplantation and PD were performed in another patient. In all patients, R0 resection was achieved. Four patients developed minor surgical complications, even though the bilioenteric anastomoses were sewn to PDT-pretreated bile ducts. No viable tumor cells were found in the inner 4 mm layer of the surgical specimens. The PDT-pretreated epithelium of the tumor-free proximal resection margins exhibited only minimal inflammatory infiltration. Tumors recurred in 2 patients 6 and 19 months after surgery. The 1-year recurrence free survival rate was 83%.
Neoadjuvant PDT for hilar CC is a low-risk procedure with efficient selective destruction of the superficial 4 mm layer of bile duct tumor without complications exceeding series without neoadjuvant PDT. Neoadjuvant PDT should be evaluated prospectively to determine whether it reduces the rate of local disease recurrence after potentially curative resection.
肝门部胆管癌（CC）患者中仅有20% - 30%适合进行可能治愈性切除。然而，即使进行了根治性（R0）切除，这些患者的疾病复发率仍高达76%。当前这项前瞻性II期研究调查了光动力疗法（PDT）作为CC的新辅助治疗方法。
对7例晚期近端胆管癌患者进行了评估。患者在肿瘤浸润区域及超出该区域2 cm处接受PDT治疗，中位6周（范围3 - 44周）后接受手术。
1例患者为Bismuth - Corlette II型肿瘤，2例为IIIa型，1例为IIIb型，3例为IV型。PDT后胆汁淤积参数显著下降。除1例患者术中出现轻微光毒性外，未发生与PDT相关的不良事件。3例患者接受了右侧肝切除，2例患者接受了左侧肝切除，1例患者因肿瘤侵犯远端胆管接受了肝门联合部分胰十二指肠切除术（PD）。另1例患者接受了肝移植和PD。所有患者均实现了R0切除。4例患者出现轻微手术并发症，尽管胆肠吻合口是缝合在经PDT预处理的胆管上。手术标本内4 mm层未发现存活肿瘤细胞。无肿瘤近端切缘经PDT预处理的上皮仅表现出轻微炎症浸润。2例患者术后6个月和19个月出现肿瘤复发。1年无复发生存率为83%。
肝门部CC的新辅助PDT是一种低风险手术，能有效选择性破坏胆管肿瘤表面4 mm层，且并发症不超过未进行新辅助PDT的系列病例。应前瞻性评估新辅助PDT是否能降低可能治愈性切除后局部疾病复发率。
