Oncology Center, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation, University Clinical Hospital no. 1, Bolshaya Pirogovskaya str., 6, Moscow, 119435, Russia.
Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilov str., 38, Moscow, 119991, Russia.
Photodiagnosis Photodyn Ther. 2019 Jun;26:218-223. doi: 10.1016/j.pdpdt.2019.04.006. Epub 2019 Apr 6.
The five-year survival rate for successful surgical treatment of cholangiocellular cancer is only 20-40%, and in the case of an unresectable tumor, the life expectancy does not usually exceed 6 months. Survival decreases with the presence of jaundice, due to the spread of the tumor process along the bile ducts, leading to their obstruction. We report outcomes of patients with nonresectable bile duct carcinoma complicated by obstructive jaundice treated with Photodynamic Therapy (PDT).
Combined diagnosis and treatment included percutaneous cholangiostomy, intraductal video fluorescence diagnostics, photodynamic therapy, and bile duct stenting. All patients were treated at the Sechenov University Oncology Center in Moscow. The results of treatment of 33 patients have been presented. The intraductal diagnosis of malignant bile duct lesions was performed after cholangiostomy using the endovideofluorescence module for minimally invasive surgery and endoscopy. With the use of this method, it is the first time in Russia that it has become possible to obtain a videofluorescent image of the tumor and to determine the high level of photosensitizer accumulation in all cholangiocarcinoma patients. The preparations Photolon, Radachlorin, and Photosens were employed as photosensitizers (PS). Intraductal photodynamic therapy was used to achieve the antitumor effect. Laser power density was about 200 mW/cm.
We present initial results, improved the diagnostic possibilities in this difficult localization of carcinoma, and demonstrated the feasibility of prolongation of life without significant deterioration of its quality. The average survival time in the treatment group is 9.5 months.
The treatment of patients with nonresectable cholangiocarcinoma with Photodynamic Therapy should be an available option. In this context, the additional use of intraductal endovideofluorescence diagnostics is a highly specific technique that allows reliable detection of the photosensitizer accumulation predominantly by the tumor tissue and appears promising. As shown by our experience, flourescent localization followed by Photodynamic Therapy, enabled us to improve diagnostic techniques and treat the tumor with improved outcome.
成功进行胆管细胞癌手术治疗的五年生存率仅为 20-40%，对于不可切除的肿瘤，预期寿命通常不超过 6 个月。由于肿瘤沿胆管扩散，导致胆管阻塞，黄疸的存在会降低生存机会。我们报告了采用光动力疗法（PDT）治疗不可切除胆管癌合并梗阻性黄疸患者的结果。
联合诊断和治疗包括经皮胆管造口术、腔内视频荧光诊断、光动力治疗和胆管支架置入。所有患者均在莫斯科谢切诺夫大学肿瘤中心接受治疗。报告了 33 例患者的治疗结果。在经皮胆管造口术后，使用微创外科和内镜的腔内视频荧光模块对恶性胆管病变进行腔内诊断。通过使用这种方法，俄罗斯首次能够获得胆管癌患者肿瘤的视频荧光图像，并确定所有患者的光敏剂高蓄积水平。光敏剂（PS）制剂 Photolon、Radachlorin 和 Photosens 用于光动力治疗以达到抗肿瘤效果。激光功率密度约为 200 mW/cm。
我们提供了初步结果，改善了在这个困难部位的癌的诊断可能性，并证明了在不显著降低其质量的情况下延长生命的可行性。治疗组的平均生存时间为 9.5 个月。
光动力疗法治疗不可切除的胆管癌应是一种可行的选择。在这种情况下，腔内视频荧光诊断的额外使用是一种高度特异的技术，可通过肿瘤组织可靠地检测到光敏剂的蓄积，并且具有很大的应用前景。根据我们的经验，荧光定位后进行光动力治疗，使我们能够改进诊断技术，并改善肿瘤的治疗效果。
