Photodynamic therapy for cholangiocarcinoma using low dose mTHPC (Foscan® )

• Published in: Photodiagnosis and photodynamic therapy Vol. 10; no. 3; pp. 220 - 228
• Main Authors: Kniebühler, Gesa, Pongratz, Thomas, Betz, Christian S, Göke, Burkhard, Sroka, Ronald, Stepp, Herbert, Schirra, Jörg
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-09-2013
• Subjects: Aged; Aged, 80 and over; Bile Duct Neoplasms - diagnosis; Bile Duct Neoplasms - therapy; Bile Ducts, Intrahepatic - drug effects; Bile Ducts, Intrahepatic - radiation effects; Bile Ducts, Intrahepatic - surgery; Cholangiocarcinoma; Cholangiocarcinoma - therapy; Dose-Response Relationship, Drug; Female; Fluorescence kinetics; Foscan® PDT; Hematology, Oncology and Palliative Medicine; Humans; Internal Medicine; Male; Mesoporphyrins - administration & dosage; Middle Aged; mTHPC; Photochemotherapy; Photosensitizing Agents - administration & dosage; Stents; Survival Rate; Treatment Outcome; Fluorescence kinetics; mTHPC; Foscan ® PDT; Cholangiocarcinoma; Foscan® PDT; Foscan(®) PDT
• ISSN: 1572-1000; 1873-1597
• DOI: 10.1016/j.pdpdt.2012.12.005

Summary Background Photodynamic therapy (PDT) combined with stenting is an effective treatment modality for palliation of nonresectable cholangiocarcinoma (CC). A drawback of standard PDT using Photofrin® as photosensitizer is the long lasting skin photosensitivity of up to 3 months. The aim of this study was to show the outcome of PDT of CC, potential side effects and to determine the best drug light interval (DLI) using mTHPC (Foscan® ) at a low dose. Methods 13 patients with nonresectable CC were treated with stenting and PDT (3 mg Foscan® per treatment, 0.032–0.063 mg/kg body weight, 652 nm, 50 J/cm). Fluorescence measurements were performed with a single bare fiber for 5/13 patients prior to PDT at the tumor site to determine the fluorescence contrast. For another 7/13 patients, long-term fluorescence-kinetics were measured on the oral mucosa to determine the time of maximal relative fluorescence intensity. Results The results so far indicate a median survival time of 13 months. Side effects such as perforations or skin phototoxicity could not be observed. Foscan® fluorescence within the tumor site was clearly detectable but a significant fluorescence contrast of tumor to adjacent healthy tissue could not be found. The fluorescence kinetics measured in the oral mucosa showed a maximum at 3.85 days (median) after drug administration. Conclusion Combined stenting and PDT performed with a low Foscan® dose results in equal and potentially longer survival times compared to standard Photofrin® PDT, while lowering the risk of side effects strongly. Thus it may improve the quality of life.