Photodynamic therapy for cholangiocarcinoma

The prognosis of perihilar cholangiocarcinoma (CC) is limited by tumor spread along the biliary tree leading to refractory obstructive cholestasis, cholangitis, and liver failure. Palliation with biliary endoprostheses yields median survival times between 4 and 6 months for nonresectable CC. Tumor ablation with photodynamic therapy (PDT) combined with biliary stenting reduces cholestasis and significantly improves median survival time to 11.5 to 16.2 months. PDT with porfimer and laser light of 630 nm provides tumoricidal tissue penetration to a depth of only 4 to 4.5 mm that does not eradicate most tumors. Time to progression lasts approximately 6 months; in other words, PDT is required twice annually. PDT costs less and enhances quality of life and survival time as compared with chemotherapy for metastatic colon cancer. These data suggest that PDT should be offered as part of the palliative treatment of CC in hepatobiliary referral centers.