Elsevier

Journal of Hepatology

Volume 32, Issue 2, February 2000, Pages 352-357
Journal of Hepatology

Case Report
Neoadjuvant photodynamic therapy before curative resection of proximal bile duct carcinoma

https://doi.org/10.1016/S0168-8278(00)80083-5Get rights and content

Abstract

Background: Hilar bile duct carcinoma has an 80% probability of local recurrence after curative resection, which might be reduced if neoadjuvant photodynamic therapy is feasible.

Case and Treatment: After intravenous injection of sodium porfimer we treated an adenocarcinoma of the proximal common bile duct (T2 N0 M0, Bismuth type II) in a 72-year-old man with red laser light (applied from the lumen at a dose 250 Joules/cm2), and the adjacent right and left hepatic and common bile duct at a dose of 125 Joules/cm2. After 23 days the tumor was completely resected (adenocarcinoma pT2 pN0; G2).

Results: In the lumenal, 4-mm-thick layer the bile duct specimen exhibited complete tumor necrosis with pigmentation of photodegraded porfimer and no viable tumor cells, while in the outer layer of the wall (at 5–8-mm depth) viable cancer cell nests without degraded porfimer were seen. The bile duct tissue showed little damage. Eighteen months after surgery, neither tumor recurrence nor stricture formation was found at the pretreated bilioenteric anastomoses.

Conclusions: a) Photodynamic therapy with sodium porfimer seems to be confined to the superficial 4-mm layer of bile duct cancer. b) Neoadjuvant photodynamic therapy is feasible for hilar bile duct carcinoma.

Section snippets

Case and Photodynamic Treatment

A 72-year-old Caucasian male was evaluated for obstructive cholestasis of 4 weeks duration. Seven and five years ago he had been treated for highly differentiated squamous cell carcinoma of the right tonsil, so far without evidence of tumor recurrence. On physical examination he appeared slightly icteric, without signs of chronic liver disease. The liver was non-tender and palpable 2 cm below the right costal margin; the spleen was not enlarged. He had irregular heart rate (88/min) with

Results

Twenty-two hours after administration of sodium porfimer, the adenocarcinoma exhibited 2.4-fold enrichment of porfimer-specific fluorescence as compared with the adjacent normal bile duct epithelium (Fig. 3A and B). In serial cross-sections of the surgical specimen, the wall of the tumor stenosis contained necroses with brown pigment of degraded photosensitizer and a dense inflammatory infiltrate in the inner layer within 4 mm distance from the lumen; no viable tumor cells were found in this

Discussion

Most malignant tumors of the proximal common bile duct and its bifurcation are differentiated adenocarcinomas with small tumor mass at diagnosis 1., 3.. However, only about 20% of them are suited for curative resection, and the large majority (75%–80%) recur for two reasons - lymphatic extension and multifocal extension in the bile ducts 5., 6., 7., 8., 9., 10.. The present case shows the effectiveness and limitations of photodynamic treatment with sodium porfimer and the feasibility of

Acknowledgements

The authors wish to thank Dr. Reinhold Baumgartner, Laser Center at Klinikum Großhadern of the Ludwig-Maximilians University in Munich and Dr. Maria-Anna E. J. Ortner, Klinikum Charité of the Humboldt University in Berlin for advice in technical aspects of photodynamic laser therapy.

References (29)

  • K Ouchi et al.

    Long-term survival in carcinoma of the biliary tract. Analysis of prognostic factors in 146 resections

    Arch Surg

    (1989)
  • NS Hadjis et al.

    Outcome of radical surgery in hilar cholangiocarcinoma

    Surgery

    (1990)
  • R Reding et al.

    Surgical management of 552 carcinomas of the extrahepatic bile ducts (gallbladder and periampullary tumors excluded)

    Ann Surg

    (1991)
  • H Bismuth et al.

    Management strategies in resection for hilar cholangiocarcinoma

    Ann Surg

    (1992)
  • Cited by (0)

    View full text