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Phototherapy Seems to Help in Bile-Duct Cancer Survival

Patients with cholangiocarcinoma were treated with stents alone, or stents plus laser

WEDNESDAY, April 2 (HealthDay News) -- In patients with unresectable cholangiocarcinoma, photodynamic therapy used with endoscopic retrograde cholangiopancreatography (ERCP) may improve survival compared with just ERCP, according to research published in the March issue of Clinical Gastroenterology and Hepatology.

Michel Kahaleh, M.D., of the University of Virginia Health System in Charlottesville, Va., and colleagues analyzed data from 19 patients treated with stents and photodynamic therapy -- using porfimer sodium as a photo-sensitizer and a diode laser system -- and another 29 subjects who served as a control group and were treated with only biliary stents.

Patients in the photodynamic therapy (PDT) group survived significantly longer (16.2 months versus 7.4 months) and mortality at three and six months was significantly lower than in the stent group (0 versus 28 percent, 16 versus 52 percent, respectively).

"PDT is thought to destroy cancer and neovascular cells and to induce tumor thrombosis through formation of cytotoxic reaction products, including singlet oxygen radicals. Understanding that survival in cholangiocarcinoma is related to the efficacy of biliary decompression, PDT offers a logical mechanism to use. The efficacy of stenting is limited by stent patency; unlike benign conditions, no tissue remodeling is affected by stenting tumor," the authors write. "PDT offers the possibility of 'remodeling' tumoral mass, which might enhance or prolong the decompressive effect. Accepting this hypothesis, PDT could improve cholestasis and survival in the setting of incomplete decompression with stents by opening previously inaccessible segments, an observation noted by ourselves and others."

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