Intraductal Photodynamic Therapy of Hilar Cholangiocarcinoma in Inoperable Patients
Aim. To research the influence of intraductal photodynamic therapy (PDT) on the duration and life quality in patients with inoperable hilar cholangiocarcinoma. Material and Methods. 39 patients aged 34-75 years with Klatskin tumor (Bismuth type IV) underwent one hundred and eighteen PDT procedures for the period 2008-2015. All patients had 1-4 percutaneous bile duct drains. The second generation of chlorin sensitizers were administrated intravenously two to four hours prior to the consecutive intraductal laser irradiation. Irradiation of affected ducts were performed using flexible optical fiber injected by original method under X-ray control. Laser irradiation was performed in a pulsed mode, the radiation dose was determined individually depending on lesion severity. Diagnosis of tumors and dynamic control were performed using morphological examination, cholangiography and MRI. Results. Follow-up was 2-47 months. There was no postoperative mortality. Three patients had post-procedural complications including liver abscess in one and gallbladder empyema in two cases that required minimally invasive interventions. The intraductal PDT reduced incidence of cholangitis exacerbation and improved quality of life. The median survival was 16 months (2-47), after the first PDT procedure and 31 months (5-69) after diagnosis. 1-, 2-, 3-, 4- and 5-year survival rates were 88%, 68%, 39%, 14,8% and 5% respectively. Conclusion. Intraductal PDT is perspective to improve both survival rate and quality of life in inoperable patients.