Nanashima Atsushi, Yamaguchi Hiroyuki, Shibasaki Shinichi, Ide Noboru, Sawai Terumitsu, Tsuji Takashi, Hidaka Shigekazu, Sumida Yorihisa, Nakagoe Tohru, Nagayasu Takeshi
Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, 852-8501, Nagasaki, Japan.
J Gastroenterol. 2004 Nov;39(11):1095-101. doi: 10.1007/s00535-004-1449-z.
Photodynamic therapy (PDT) is a new palliative option in patients with non-resectable bile duct carcinoma (BDC). Here, we assessed the efficacy of adjuvant photodynamic therapy in eight patients with BDC who underwent surgical resection.
Five patients had extrahepatic BDC, two had intrahepatic cholangiocarcinoma, and one had ampullary carcinoma. Cancer cells were microscopically detected in the stump of the hepatic duct in six patients, and biliary stenosis caused by remnant tumor was observed in one patient. One patient had tumor recurrence with occlusion of the bile duct. At 48 h prior to PDT, porfimer sodium was injected intravenously. A pulse laser by an eximer dye laser (50-100 J/cm2) with a wavelength of 630 microm was applied through an endoscope to the hepatic stump or tumor lesion.
Marked destruction of the tumor and ductal epithelium was observed on day 1 after PDT. After PDT, four patients developed mild dermatitis, but no severe morbidity or mortality was noted. In patients who underwent PDT for the stump, one patient showed distant metastasis at 31 months, and four patients did not show tumor recurrence at 17, 12, 12, and 6 months, respectively. However, one of the eight patients died at 2 months, of an unrelated cause. In two patients with occlusion caused by tumor growth, resolution of bile duct stenosis was noted on day 7. These patients showed re-occlusion by tumor at 20 and 8 months.
Adjuvant PDT is a safe and useful option for a better survival benefit in patients with BDC undergoing surgical resection.
光动力疗法（PDT）是不可切除胆管癌（BDC）患者的一种新的姑息治疗选择。在此，我们评估了辅助光动力疗法对8例接受手术切除的BDC患者的疗效。
5例为肝外BDC，2例为肝内胆管癌，1例为壶腹癌。6例患者肝管残端镜下检测到癌细胞，1例患者观察到残余肿瘤引起的胆管狭窄。1例患者肿瘤复发并伴有胆管阻塞。在光动力疗法前48小时，静脉注射卟吩姆钠。通过准分子染料激光（波长630微米，能量密度50 - 100 J/cm²）产生的脉冲激光经内镜照射肝残端或肿瘤病灶。
光动力疗法后第1天观察到肿瘤和导管上皮明显破坏。光动力疗法后，4例患者出现轻度皮炎，但未观察到严重的并发症或死亡。接受肝残端光动力疗法的患者中，1例在31个月时出现远处转移，4例患者分别在17、12、12和6个月时未出现肿瘤复发。然而，8例患者中有1例在2个月时因无关原因死亡。2例因肿瘤生长导致阻塞的患者，在第7天时胆管狭窄缓解。这些患者在20和8个月时肿瘤再次阻塞。
辅助光动力疗法对于接受手术切除的BDC患者是一种安全且有用的选择，有助于提高生存获益。
