Photodynamic therapy use for malignant neoplasms of extrahepatic bile ducts and major duodenal papilla in inoperable patients

Introduction. The article presents the results of photodynamic therapy (PDT) of extrahepatic bile ducts (EBD) and large duodenal papilla (LDP) cancer in inoperable patients. The technique of its carrying out and ways of delivery of laser light guides to various parts of biliary tract are described. Efficiency of PDT for cancer of LDP and separately for cancer of EBD was determined. The dependence of patients' life expectancy on the number of PDT sessions during a year was revealed and the comparative analysis of two groups of photosensitizers (PS) efficiency was carried out.

Research purpose: to estimate the effectiveness of photodynamic therapy (PDT) in treatment of VUC and IBD cancer; to determine the reasonability of repeated PDT courses and time intervals between them; to compare the effectiveness of photosensitizers Photodetazine and Photosens in treatment of these patients.

Materials and Methods. The study was based on a comparative analysis of life expectancy in inoperable groups of patients with VVC and IBD cancer. The main group consisted of 29 patients (including 20 patients with IBD cancer) who were treated by PDT besides biliary operations. Control group consisted of 50 patients (14 of them with BDZ cancer), only biliary drainage interventions were used in their treatment. The number of PDT courses performed was from 1 to 3 during the year. A total of 29 patients underwent 52 courses of PDT. We used two photosensitizers from different groups: Fotoditazin (chlorine derivative E6) – was used in 18 patients and Photosense (phthalocyanine derivative) – was used as PS in 11 patients. Assessment of treatment efficacy was based on determining the median survival according to the Kaplan-Meier method.

Results. Median survival time in the main group was 18 months [95% CI: 15.9; 20.1], in the comparison group (without PDT) – 7 months [95% CI: 5.1; 8.9]. In patients with IBD cancer, the median survival for PDT was 18 months [95% CI: 16; 20], and 12 months [95% CI: 9.25; 14.75] in the comparison group. Life expectancy for patients with BDS cancer ranged from 1 to 60 months. Median survival time was 17 months [95% CI: 12; 21] in case of Fotosens – 18 months [95% CI: 16; 19]. In the group of patients who underwent one PDT session during a year, median survival time was 12.5 months [95% CI: 10; 15], in the group of patients who underwent 2 or more sessions, median survival time was 23 months [95% CI: 18; 28].

Conclusions. Photodynamic therapy in combination with draining interventions on bile ducts is an effective method of therapy of inoperable forms of IVC and IBD carcinoma in high risk patients. Variants of delivery of laser radiation for PDT are developed. Repeated sessions of PDT at intervals of 4-6 months potentiate the effectiveness of palliative therapy and increase life expectancy of patients. The effectiveness of Fioditazine and Photosense in PDT was found to be similar. Fotoditazine showed a lower number of complications. 

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