Harewood Gavin C, Baron Todd H, Rumalla Ashwin, Wang Kenneth K, Gores Gregory J, Stadheim Linda M, de Groen Piet C
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
J Gastroenterol Hepatol. 2005 Mar;20(3):415-20. doi: 10.1111/j.1440-1746.2005.03582.x.
Photodynamic therapy (PDT) has demonstrated promise in the palliative treatment of advanced cholangiocarcinoma. The aim of this pilot study was to assess the outcome in patients with non-resectable cholangiocarcinoma following endoscopic application of PDT directly into the biliary tract.
In patients with advanced cholangiocarcinoma, endoscopic retrograde cholangiopancreatography (ERCP) was performed to define the proximal and distal extent of intraductal tumor. Sodium porfimer was administered intravenously to all patients. Forty-eight hours later, a commercially available cylindrical diffusing laser fiber (1-2.5 cm in length, OptiGuide) designed for esophageal use was advanced across the biliary strictures. Laser light was applied at a power of 400 mW/cm fiber for a total energy of 180 J/cm(2) using an argon-pumped tunable dye laser. Patients received endoscopic PDT every 3 months provided they maintained a favorable performance status. Plastic biliary stents were replaced immediately following light application and were maintained in all patients.
Using a preloaded catheter, adequate positioning of the laser fiber was achieved in all patients. Eight patients with advanced cholangiocarcinoma received a total of 19 PDT treatments, range 1-5 treatments/patient. All eight patients were followed until death; mean follow-up was 9.8 months. Median survival from the date of the first PDT treatment was 276 days, which compares favorably with published series that have reported median survival times between 45 and 127 days for patients with bismuth type III and IV tumors treated with stenting alone.
Endoscopic application of PDT demonstrates promise in prolonging survival in patients with advanced cholangiocarcinoma. Additional randomized clinical trials using commercially available fibers are needed to fully evaluate both the optimum frequency and treatment interval of endoscopic PDT in the management of advanced cholangiocarcinoma.
光动力疗法（PDT）在晚期胆管癌的姑息治疗中已显示出前景。本初步研究的目的是评估将PDT经内镜直接应用于胆道后，不可切除胆管癌患者的治疗结果。
对于晚期胆管癌患者，进行内镜逆行胰胆管造影（ERCP）以确定导管内肿瘤的近端和远端范围。所有患者均静脉注射卟吩姆钠。48小时后，将一种市售的用于食管的圆柱形扩散激光纤维（长度为1 - 2.5厘米，OptiGuide）穿过胆管狭窄部位。使用氩泵浦可调染料激光，以400 mW/cm纤维的功率施加激光，总能量为180 J/cm²。只要患者保持良好的身体状况，每3个月接受一次内镜PDT治疗。在照射光后立即更换塑料胆管支架，并在所有患者中维持使用。
使用预装导管，所有患者均实现了激光纤维的充分定位。8例晚期胆管癌患者共接受了19次PDT治疗，每位患者接受1 - 5次治疗。所有8例患者均随访至死亡；平均随访时间为9.8个月。从首次PDT治疗之日起的中位生存期为276天，这与已发表的系列研究相比具有优势，那些研究报道单独使用支架治疗的铋III型和IV型肿瘤患者的中位生存时间为45至127天。
内镜应用PDT在延长晚期胆管癌患者的生存期方面显示出前景。需要使用市售纤维进行额外的随机临床试验，以全面评估内镜PDT在晚期胆管癌管理中的最佳频率和治疗间隔。
