Pilot study to assess patient outcomes following endoscopic application of photodynamic therapy for advanced cholangiocarcinoma
Background: 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...
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| Veröffentlicht in: | Journal of gastroenterology and hepatology 2005-03, Vol.20 (3), p.415-420 |
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| creator | HAREWOOD, GAVIN C BARON, TODD H RUMALLA, ASHWIN WANG, KENNETH K GORES, GREGORY J STADHEIM, LINDA M DE GROEN, PIET C |
| description | Background: 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.
Methods: 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/cm2 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.
Results: 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.
Conclusions: 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. |
| doi_str_mv | 10.1111/j.1440-1746.2005.03582.x |
| format | Article |
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Methods: 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/cm2 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.
Results: 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.
Conclusions: 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.</description><identifier>ISSN: 0815-9319</identifier><identifier>EISSN: 1440-1746</identifier><identifier>DOI: 10.1111/j.1440-1746.2005.03582.x</identifier><identifier>PMID: 15740486</identifier><language>eng</language><publisher>Melbourne, Australia: Blackwell Science Pty</publisher><subject>Adult ; Aged ; Antineoplastic Agents - administration & dosage ; Antineoplastic Agents - therapeutic use ; Bile Duct Neoplasms - diagnosis ; Bile Duct Neoplasms - mortality ; Bile Duct Neoplasms - therapy ; Bile Ducts, Intrahepatic - diagnostic imaging ; Bile Ducts, Intrahepatic - pathology ; Bile Ducts, Intrahepatic - surgery ; Biological and medical sciences ; Cell Line, Tumor ; cholangiocarcinoma ; Cholangiocarcinoma - diagnosis ; Cholangiocarcinoma - mortality ; Cholangiocarcinoma - therapy ; Cholangiopancreatography, Endoscopic Retrograde - methods ; Dihematoporphyrin Ether - administration & dosage ; Dihematoporphyrin Ether - therapeutic use ; Diseases of the skin. Cosmetics ; endoscopy ; Follow-Up Studies ; Gastroenterology. Liver. Pancreas. Abdomen ; Humans ; Laser Therapy ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Medical sciences ; Middle Aged ; Photochemotherapy - methods ; photodynamic therapy ; Pilot Projects ; Prosthesis Implantation - instrumentation ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Retrospective Studies ; Stents ; Survival Rate ; Treatment Outcome ; Tumors</subject><ispartof>Journal of gastroenterology and hepatology, 2005-03, Vol.20 (3), p.415-420</ispartof><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4352-ed8f1ab771395344f2aa35513bbce0b91e091a533d341dd6e1e6a1f60190d10a3</citedby><cites>FETCH-LOGICAL-c4352-ed8f1ab771395344f2aa35513bbce0b91e091a533d341dd6e1e6a1f60190d10a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1440-1746.2005.03582.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1440-1746.2005.03582.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27922,27923,45572,45573</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16888498$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15740486$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>HAREWOOD, GAVIN C</creatorcontrib><creatorcontrib>BARON, TODD H</creatorcontrib><creatorcontrib>RUMALLA, ASHWIN</creatorcontrib><creatorcontrib>WANG, KENNETH K</creatorcontrib><creatorcontrib>GORES, GREGORY J</creatorcontrib><creatorcontrib>STADHEIM, LINDA M</creatorcontrib><creatorcontrib>DE GROEN, PIET C</creatorcontrib><title>Pilot study to assess patient outcomes following endoscopic application of photodynamic therapy for advanced cholangiocarcinoma</title><title>Journal of gastroenterology and hepatology</title><addtitle>J Gastroenterol Hepatol</addtitle><description>Background: 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.
Methods: 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/cm2 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.
Results: 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.
Conclusions: 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.</description><subject>Adult</subject><subject>Aged</subject><subject>Antineoplastic Agents - administration & dosage</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Bile Duct Neoplasms - diagnosis</subject><subject>Bile Duct Neoplasms - mortality</subject><subject>Bile Duct Neoplasms - therapy</subject><subject>Bile Ducts, Intrahepatic - diagnostic imaging</subject><subject>Bile Ducts, Intrahepatic - pathology</subject><subject>Bile Ducts, Intrahepatic - surgery</subject><subject>Biological and medical sciences</subject><subject>Cell Line, Tumor</subject><subject>cholangiocarcinoma</subject><subject>Cholangiocarcinoma - diagnosis</subject><subject>Cholangiocarcinoma - mortality</subject><subject>Cholangiocarcinoma - therapy</subject><subject>Cholangiopancreatography, Endoscopic Retrograde - methods</subject><subject>Dihematoporphyrin Ether - administration & dosage</subject><subject>Dihematoporphyrin Ether - therapeutic use</subject><subject>Diseases of the skin. Cosmetics</subject><subject>endoscopy</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Humans</subject><subject>Laser Therapy</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Photochemotherapy - methods</subject><subject>photodynamic therapy</subject><subject>Pilot Projects</subject><subject>Prosthesis Implantation - instrumentation</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Retrospective Studies</subject><subject>Stents</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><issn>0815-9319</issn><issn>1440-1746</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkEGP1CAUxxujccfVr2C46K0VCpT24MFMdFZt1INmvZFXoDuMbekW6k5PfnWpM9m9ygWS9_vz3vslCSI4I_G8OWSEMZwSwYosx5hnmPIyz46Pks194XGywSXhaUVJdZE88_6AMWZY8KfJBeGCYVYWm-TPN9u5gHyY9YKCQ-C98R6NEKwZAnJzUK43HrWu69ydHW6QGbTzyo1WIRjHzqqIugG5Fo17F5xeBuhjLezNBOMSgxMC_RsGZTRSe9fBcGOdgknZwfXwPHnSQufNi_N9mfz48P779iqtv-4-bt_VqWKU56nRZUugEYLQilPG2hyAck5o0yiDm4oYXBHglGrKiNaFIaYA0haYVFgTDPQyeX36d5zc7Wx8kL31ynRxHONmLwvBhMhzHMHyBKrJeT-ZVo6T7WFaJMFylS8PcnUsV8dylS__yZfHGH157jE3vdEPwbPtCLw6A-AVdO0UrVj_wBVlWbKqjNzbE3dnO7P89wDy0-5qfcV8espbH8zxPg_Tr7gnFVxef9nJbfHzuhZ1LT_Tv0zpsk8</recordid><startdate>200503</startdate><enddate>200503</enddate><creator>HAREWOOD, GAVIN C</creator><creator>BARON, TODD H</creator><creator>RUMALLA, ASHWIN</creator><creator>WANG, KENNETH K</creator><creator>GORES, GREGORY J</creator><creator>STADHEIM, LINDA M</creator><creator>DE GROEN, PIET C</creator><general>Blackwell Science Pty</general><general>Blackwell Science</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200503</creationdate><title>Pilot study to assess patient outcomes following endoscopic application of photodynamic therapy for advanced cholangiocarcinoma</title><author>HAREWOOD, GAVIN C ; BARON, TODD H ; RUMALLA, ASHWIN ; WANG, KENNETH K ; GORES, GREGORY J ; STADHEIM, LINDA M ; DE GROEN, PIET C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4352-ed8f1ab771395344f2aa35513bbce0b91e091a533d341dd6e1e6a1f60190d10a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antineoplastic Agents - administration & dosage</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Bile Duct Neoplasms - diagnosis</topic><topic>Bile Duct Neoplasms - mortality</topic><topic>Bile Duct Neoplasms - therapy</topic><topic>Bile Ducts, Intrahepatic - diagnostic imaging</topic><topic>Bile Ducts, Intrahepatic - pathology</topic><topic>Bile Ducts, Intrahepatic - surgery</topic><topic>Biological and medical sciences</topic><topic>Cell Line, Tumor</topic><topic>cholangiocarcinoma</topic><topic>Cholangiocarcinoma - diagnosis</topic><topic>Cholangiocarcinoma - mortality</topic><topic>Cholangiocarcinoma - therapy</topic><topic>Cholangiopancreatography, Endoscopic Retrograde - methods</topic><topic>Dihematoporphyrin Ether - administration & dosage</topic><topic>Dihematoporphyrin Ether - therapeutic use</topic><topic>Diseases of the skin. Cosmetics</topic><topic>endoscopy</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Humans</topic><topic>Laser Therapy</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Photochemotherapy - methods</topic><topic>photodynamic therapy</topic><topic>Pilot Projects</topic><topic>Prosthesis Implantation - instrumentation</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Retrospective Studies</topic><topic>Stents</topic><topic>Survival Rate</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>HAREWOOD, GAVIN C</creatorcontrib><creatorcontrib>BARON, TODD H</creatorcontrib><creatorcontrib>RUMALLA, ASHWIN</creatorcontrib><creatorcontrib>WANG, KENNETH K</creatorcontrib><creatorcontrib>GORES, GREGORY J</creatorcontrib><creatorcontrib>STADHEIM, LINDA M</creatorcontrib><creatorcontrib>DE GROEN, PIET C</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>HAREWOOD, GAVIN C</au><au>BARON, TODD H</au><au>RUMALLA, ASHWIN</au><au>WANG, KENNETH K</au><au>GORES, GREGORY J</au><au>STADHEIM, LINDA M</au><au>DE GROEN, PIET C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pilot study to assess patient outcomes following endoscopic application of photodynamic therapy for advanced cholangiocarcinoma</atitle><jtitle>Journal of gastroenterology and hepatology</jtitle><addtitle>J Gastroenterol Hepatol</addtitle><date>2005-03</date><risdate>2005</risdate><volume>20</volume><issue>3</issue><spage>415</spage><epage>420</epage><pages>415-420</pages><issn>0815-9319</issn><eissn>1440-1746</eissn><abstract>Background: 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.
Methods: 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/cm2 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.
Results: 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.
Conclusions: 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.</abstract><cop>Melbourne, Australia</cop><pub>Blackwell Science Pty</pub><pmid>15740486</pmid><doi>10.1111/j.1440-1746.2005.03582.x</doi><tpages>6</tpages></addata></record> |
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| source | Wiley Online Library - AutoHoldings Journals; MEDLINE |
| subjects | Adult Aged Antineoplastic Agents - administration & dosage Antineoplastic Agents - therapeutic use Bile Duct Neoplasms - diagnosis Bile Duct Neoplasms - mortality Bile Duct Neoplasms - therapy Bile Ducts, Intrahepatic - diagnostic imaging Bile Ducts, Intrahepatic - pathology Bile Ducts, Intrahepatic - surgery Biological and medical sciences Cell Line, Tumor cholangiocarcinoma Cholangiocarcinoma - diagnosis Cholangiocarcinoma - mortality Cholangiocarcinoma - therapy Cholangiopancreatography, Endoscopic Retrograde - methods Dihematoporphyrin Ether - administration & dosage Dihematoporphyrin Ether - therapeutic use Diseases of the skin. Cosmetics endoscopy Follow-Up Studies Gastroenterology. Liver. Pancreas. Abdomen Humans Laser Therapy Liver. Biliary tract. Portal circulation. Exocrine pancreas Medical sciences Middle Aged Photochemotherapy - methods photodynamic therapy Pilot Projects Prosthesis Implantation - instrumentation Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Retrospective Studies Stents Survival Rate Treatment Outcome Tumors |
| title | Pilot study to assess patient outcomes following endoscopic application of photodynamic therapy for advanced cholangiocarcinoma |
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