Application of photodynamic therapy in palliative treatment of unresectable hilar cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YAN Xuanxuan ^1,2 , LI Duofu ¹ ,  LI Xun ^1,2,3

1. The First Clinical Medicine School of Lanzhou University, Lanzhou 730000, P. R. China;
2. The Fifth Department of General Surgery, The First Hospital Affiliated to Lanzhou University, Lanzhou 730000, P. R. China;
3. Key Laboratory of Biotherapy and Regenerative Medicine in Gansu, Lanzhou 730000, P. R. China;

Corresponding author：

LI Xun, Email: lxdr21@126.com

Keywords：

hilar cholangiocarcinoma; unresection; photodynamic therapy

DOI：

10.7507/1007-9424.201708068

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Objective To explore application value of photodynamic therapy (PDT) in treatment of unresectable hilar cholangiocarcinoma. Method The literatures about PDT in the treatment of the unresectable hilar cholangiocarcinoma in the PubMed, MedLine, Embase, CNKI, and Wanfang databases were reviewed. Results The PDT combined with stent or chemotherapy was the main method in the treatment of the unresectable hilar cholangiocarcinoma, which could make the tumor down-staging, obviously reduce the jaundice, improve the quality of life, improve the survival rate, prolong the stent patency and be treated repeatedly. Especially, it was suitable for the patients with elderly, poor health, intolerance of surgery, could partly replace the R1 or R2 operation of hilar cholangiocarcinoma and avoid the risk of surgery and postoperative complications. The therapeutic effective of the PDT was related to the early therapy and times of therapy. However, the shortcomes of the PDT were that the depth of killing tumor was not enough and there was a certain incidence of adverse reaction. Conclusions Therapeutic effect of PDT combine with stent or chemotherapy for unresectable hilar cholangiocarcinoma is better than that of single therapy. It is expected to be a first-line scheme of palliative treatment for unresectable hilar cholangiocarcinoma.

Citation： YAN Xuanxuan, LI Duofu, LI Xun. Application of photodynamic therapy in palliative treatment of unresectable hilar cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(4): 488-492. doi: 10.7507/1007-9424.201708068 Copy

1.	Ghouri YA, Mian I, Blechacz B. Cancer review: Cholangiocarcinoma. J Carcinog, 2015, 14: 1.
2.	Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T, et al. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol, 2013, 28(4): 593-607.
3.	Goenka MK, Goenka U. Palliation: Hilar cholangiocarcinoma. World J Hepatol, 2014, 6(8): 559-569.
4.	Weiss MJ, Cosgrove D, Herman JM, et al. Multimodal treatment strategies for advanced hilar cholangiocarcinoma. Langenbecks Arch Surg, 2014, 399(6): 679-692.
5.	张宪祥, 卢云, 冯玉杰, 等. 肝门部胆管癌外科治疗及疗效. 中华肝脏外科手术学电子杂志, 2015, 4(2): 19-22.
6.	Geng ZM, Noor H, Zheng JB, et al. Advances in diagnosis and treatment of hilar cholangiocarcinoma—a review. Med Sci Monit, 2013, 19: 648-656.
7.	李志原, 李小祺, 崔培元. 不可切除肝门胆管癌的光动力学治疗现状. 中国肿瘤临床, 2016, 43(16): 735-738.
8.	陈勇, 李婉婉, 周江蛟, 等. 光动力疗法分子机制研究进展. 中南大学学报(医学版), 2014, 39(1): 102-108.
9.	Zhao L, Kim TH, Kim HW, et al. Enhanced cellular uptake and phototoxicity of verteporfin-conjugated gold nanoparticles as theranostic nanocarriers for targeted photodynamic therapy and imaging of cancers. Mater Sci Eng C Mater Biol Appl, 2016, 67: 611-622.
10.	Kessel D, Oleinick NL. Cell death pathways associated with photodynamic therapy: an update. Photochem Photobiol, 2017 Nov 16. doi: 10.1111/php.12857.
11.	Almeida RD, Manadas BJ, Carvalho AP, et al. Intracellular signaling mechanisms in photodynamic therapy. Biochim Biophys Acta, 2004, 1704(2): 59-86.
12.	Wachowska M, Muchowicz A, Demkow U. Immunological aspects of antitumor photodynamic therapy outcome. Cent Eur J Immunol, 2015, 40(4): 481-485.
13.	Cheon YK, Lee TY, Lee SM, et al. Longterm outcome of photodynamic therapy compared with biliary stenting alone in patients with advanced hilar cholangiocarcinoma. HPB (Oxford), 2012, 14(3): 185-193.
14.	Witzigmann H, Berr F, Ringel U, et al. Surgical and palliative management and outcome in 184 patients with hilar cholangiocarcinoma: palliative photodynamic therapy plus stenting is comparable to R1/R2 resection. Ann Surg, 2006, 244(2): 230-239.
15.	Matull WR, Dhar DK, Ayaru L, et al. R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer. Liver Int, 2011, 31(1): 99-107.
16.	Lee TY, Cheon YK, Shim CS, et al. Photodynamic therapy prolongs metal stent patency in patients with unresectable hilar cholangiocarcinoma. World J Gastroenterol, 2012, 18(39): 5589-5594.
17.	Kahaleh M, Mishra R, Shami VM, et al. Unresectable cholangiocarcinoma: comparison of survival in biliary stenting alone versus stenting with photodynamic therapy. Clin Gastroenterol Hepatol, 2008, 6(3): 290-297.
18.	Quyn AJ, Ziyaie D, Polignano FM, et al. Photodynamic therapy is associated with an improvement in survival in patients with irresectable hilar cholangiocarcinoma. HPB (Oxford), 2009, 11(7): 570-577.
19.	Strand DS, Cosgrove ND, Patrie JT, et al. ERCP-directed radiofrequency ablation and photodynamic therapy are associated with comparable survival in the treatment of unresectable cholangiocarcinoma. Gastrointest Endosc, 2014, 80(5): 794-804.
20.	Shimizu S, Nakazawa T, Hayashi K, et al. Photodynamic Therapy using Talaporfin Sodium for the Recurrence of Cholangiocarcinoma after Surgical Resection. Intern Med, 2015, 54(18): 2321-2326.
21.	胡骁, 胡维昱, 孙传东, 等. 肝门部胆管癌根治性切除术后并发症的诊断与治疗. 中华肝脏外科手术学电子杂志, 2015, 4(4): 206-209.
22.	Weijer R, Broekgaarden M, van Golen RF, et al. Low-power photodynamic therapy induces survival signaling in perihilar cholangiocarcinoma cells. BMC Cancer, 2015, 15: 1014.
23.	Wagner A, Wiedmann M, Tannapfel A, et al. Neoadjuvant down-sizing of hilar cholangiocarcinoma with photodynamic therapy—long-term outcome of a phase Ⅱ pilot study. Int J Mol Sci, 2015, 16(11): 26619-26628.
24.	Wiedmann M, Caca K, Berr F, et al. Neoadjuvant photodynamic therapy as a new approach to treating hilar cholangiocarcinoma: a phase Ⅱ pilot study. Cancer, 2003, 97(11): 2783-2790.
25.	Prasad GA, Wang KK, Baron TH, et al. Factors associated with increased survival after photodynamic therapy for cholangiocarcinoma. Clin Gastroenterol Hepatol, 2007, 5(6): 743-748.
26.	Dolak W, Schwaighofer H, Hellmich B, et al. Photodynamic therapy with polyhematoporphyrin for malignant biliary obstruction: A nationwide retrospective study of 150 consecutive applications. United European Gastroenterol J, 2017, 5(1): 104-110.
27.	Hong MJ, Cheon YK, Lee EJ, et al. Long-term outcome of photodynamic therapy with systemic chemotherapy compared to photodynamic therapy alone in patients with advanced hilar cholangiocarcinoma. Gut Liver, 2014, 8(3): 318-323.
28.	Shim CS, Cheon YK, Cha SW, et al. Prospective study of the effectiveness of percutaneous transhepatic photodynamic therapy for advanced bile duct cancer and the role of intraductal ultrasonography in response assessment. Endoscopy, 2005, 37(5): 425.
29.	Lee TY, Cheon YK, Shim CS. Photodynamic therapy in patients with advanced hilar cholangiocarcinoma: percutaneous cholangioscopic versus peroral transpapillary approach. Photomed Laser Surg, 2016, 34(4): 150-156.
30.	余继海, 邱陆军, 马金良, 等. 影响非手术治疗肝门部胆管癌预后因素分析. 肝胆外科杂志, 2008, 16(4): 281-283.
31.	Wentrup R, Winkelmann N, Mitroshkin A, et al. Photodynamic therapy plus chemotherapy compared with photodynamic therapy alone in hilar nonresectable cholangiocarcinoma.Gut Liver, 2016, 10(3): 470-475.
32.	Park DH, Lee SS, Park SE, et al. Randomised phase Ⅱ trial of photodynamic therapy plus oral fluoropyrimidine, S-1, versus photodynamic therapy alone for unresectable hilar cholangiocarcinoma. Eur J Cancer, 2014, 50(7): 1259-1268.
33.	Zoepf T, Jakobs R, Arnold JC, et al. Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy. Am J Gastroenterol, 2005, 100(11): 2426-2430.
34.	Lee IS, Wang H, Chae Y, et al. Functional neuroimaging studies in functional dyspepsia patients: a systematic review. Neurogastroenterol Motil, 2016, 28(6): 793-805.
35.	Patel J, Rizk N, Kahaleh M. Role of photodynamic therapy and intraductal radiofrequency ablation in cholangiocarcinoma. Best Pract Res Clin Gastroenterol, 2015, 29(2): 309-318.
36.	Nanashima A, Nagayasu T. Current status of photodynamic therapy in digestive tract carcinoma in Japan. Int J Mol Sci, 2015, 16(2): 3434-3440.
37.	Pereira SP, Aithal GP, Ragunath K, et al. Safety and long term efficacy of porfimer sodium photodynamic therapy in locally advanced biliary tract carcinoma. Photodiagnosis Photodyn Ther, 2012, 9(4): 287-292.
38.	Smith I, Kahaleh M. Biliary tumor ablation with photodynamic therapy and radiofrequency ablation. Gastrointest Endosc Clin N Am, 2015, 25(4): 793-804.
39.	汪昕, 郑建伟, 邹声泉. 光动力疗法在抗肿瘤血管方面的应用. 临床外科杂志, 2007, 15(4): 277-278.

1. Ghouri YA, Mian I, Blechacz B. Cancer review: Cholangiocarcinoma. J Carcinog, 2015, 14: 1.
2. Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T, et al. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol, 2013, 28(4): 593-607.
3. Goenka MK, Goenka U. Palliation: Hilar cholangiocarcinoma. World J Hepatol, 2014, 6(8): 559-569.
4. Weiss MJ, Cosgrove D, Herman JM, et al. Multimodal treatment strategies for advanced hilar cholangiocarcinoma. Langenbecks Arch Surg, 2014, 399(6): 679-692.
5. 张宪祥, 卢云, 冯玉杰, 等. 肝门部胆管癌外科治疗及疗效. 中华肝脏外科手术学电子杂志, 2015, 4(2): 19-22.
6. Geng ZM, Noor H, Zheng JB, et al. Advances in diagnosis and treatment of hilar cholangiocarcinoma—a review. Med Sci Monit, 2013, 19: 648-656.
7. 李志原, 李小祺, 崔培元. 不可切除肝门胆管癌的光动力学治疗现状. 中国肿瘤临床, 2016, 43(16): 735-738.
8. 陈勇, 李婉婉, 周江蛟, 等. 光动力疗法分子机制研究进展. 中南大学学报(医学版), 2014, 39(1): 102-108.
9. Zhao L, Kim TH, Kim HW, et al. Enhanced cellular uptake and phototoxicity of verteporfin-conjugated gold nanoparticles as theranostic nanocarriers for targeted photodynamic therapy and imaging of cancers. Mater Sci Eng C Mater Biol Appl, 2016, 67: 611-622.
10. Kessel D, Oleinick NL. Cell death pathways associated with photodynamic therapy: an update. Photochem Photobiol, 2017 Nov 16. doi: 10.1111/php.12857.
11. Almeida RD, Manadas BJ, Carvalho AP, et al. Intracellular signaling mechanisms in photodynamic therapy. Biochim Biophys Acta, 2004, 1704(2): 59-86.
12. Wachowska M, Muchowicz A, Demkow U. Immunological aspects of antitumor photodynamic therapy outcome. Cent Eur J Immunol, 2015, 40(4): 481-485.
13. Cheon YK, Lee TY, Lee SM, et al. Longterm outcome of photodynamic therapy compared with biliary stenting alone in patients with advanced hilar cholangiocarcinoma. HPB (Oxford), 2012, 14(3): 185-193.
14. Witzigmann H, Berr F, Ringel U, et al. Surgical and palliative management and outcome in 184 patients with hilar cholangiocarcinoma: palliative photodynamic therapy plus stenting is comparable to R1/R2 resection. Ann Surg, 2006, 244(2): 230-239.
15. Matull WR, Dhar DK, Ayaru L, et al. R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer. Liver Int, 2011, 31(1): 99-107.
16. Lee TY, Cheon YK, Shim CS, et al. Photodynamic therapy prolongs metal stent patency in patients with unresectable hilar cholangiocarcinoma. World J Gastroenterol, 2012, 18(39): 5589-5594.
17. Kahaleh M, Mishra R, Shami VM, et al. Unresectable cholangiocarcinoma: comparison of survival in biliary stenting alone versus stenting with photodynamic therapy. Clin Gastroenterol Hepatol, 2008, 6(3): 290-297.
18. Quyn AJ, Ziyaie D, Polignano FM, et al. Photodynamic therapy is associated with an improvement in survival in patients with irresectable hilar cholangiocarcinoma. HPB (Oxford), 2009, 11(7): 570-577.
19. Strand DS, Cosgrove ND, Patrie JT, et al. ERCP-directed radiofrequency ablation and photodynamic therapy are associated with comparable survival in the treatment of unresectable cholangiocarcinoma. Gastrointest Endosc, 2014, 80(5): 794-804.
20. Shimizu S, Nakazawa T, Hayashi K, et al. Photodynamic Therapy using Talaporfin Sodium for the Recurrence of Cholangiocarcinoma after Surgical Resection. Intern Med, 2015, 54(18): 2321-2326.
21. 胡骁, 胡维昱, 孙传东, 等. 肝门部胆管癌根治性切除术后并发症的诊断与治疗. 中华肝脏外科手术学电子杂志, 2015, 4(4): 206-209.
22. Weijer R, Broekgaarden M, van Golen RF, et al. Low-power photodynamic therapy induces survival signaling in perihilar cholangiocarcinoma cells. BMC Cancer, 2015, 15: 1014.
23. Wagner A, Wiedmann M, Tannapfel A, et al. Neoadjuvant down-sizing of hilar cholangiocarcinoma with photodynamic therapy—long-term outcome of a phase Ⅱ pilot study. Int J Mol Sci, 2015, 16(11): 26619-26628.
24. Wiedmann M, Caca K, Berr F, et al. Neoadjuvant photodynamic therapy as a new approach to treating hilar cholangiocarcinoma: a phase Ⅱ pilot study. Cancer, 2003, 97(11): 2783-2790.
25. Prasad GA, Wang KK, Baron TH, et al. Factors associated with increased survival after photodynamic therapy for cholangiocarcinoma. Clin Gastroenterol Hepatol, 2007, 5(6): 743-748.
26. Dolak W, Schwaighofer H, Hellmich B, et al. Photodynamic therapy with polyhematoporphyrin for malignant biliary obstruction: A nationwide retrospective study of 150 consecutive applications. United European Gastroenterol J, 2017, 5(1): 104-110.
27. Hong MJ, Cheon YK, Lee EJ, et al. Long-term outcome of photodynamic therapy with systemic chemotherapy compared to photodynamic therapy alone in patients with advanced hilar cholangiocarcinoma. Gut Liver, 2014, 8(3): 318-323.
28. Shim CS, Cheon YK, Cha SW, et al. Prospective study of the effectiveness of percutaneous transhepatic photodynamic therapy for advanced bile duct cancer and the role of intraductal ultrasonography in response assessment. Endoscopy, 2005, 37(5): 425.
29. Lee TY, Cheon YK, Shim CS. Photodynamic therapy in patients with advanced hilar cholangiocarcinoma: percutaneous cholangioscopic versus peroral transpapillary approach. Photomed Laser Surg, 2016, 34(4): 150-156.
30. 余继海, 邱陆军, 马金良, 等. 影响非手术治疗肝门部胆管癌预后因素分析. 肝胆外科杂志, 2008, 16(4): 281-283.
31. Wentrup R, Winkelmann N, Mitroshkin A, et al. Photodynamic therapy plus chemotherapy compared with photodynamic therapy alone in hilar nonresectable cholangiocarcinoma.Gut Liver, 2016, 10(3): 470-475.
32. Park DH, Lee SS, Park SE, et al. Randomised phase Ⅱ trial of photodynamic therapy plus oral fluoropyrimidine, S-1, versus photodynamic therapy alone for unresectable hilar cholangiocarcinoma. Eur J Cancer, 2014, 50(7): 1259-1268.
33. Zoepf T, Jakobs R, Arnold JC, et al. Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy. Am J Gastroenterol, 2005, 100(11): 2426-2430.
34. Lee IS, Wang H, Chae Y, et al. Functional neuroimaging studies in functional dyspepsia patients: a systematic review. Neurogastroenterol Motil, 2016, 28(6): 793-805.
35. Patel J, Rizk N, Kahaleh M. Role of photodynamic therapy and intraductal radiofrequency ablation in cholangiocarcinoma. Best Pract Res Clin Gastroenterol, 2015, 29(2): 309-318.
36. Nanashima A, Nagayasu T. Current status of photodynamic therapy in digestive tract carcinoma in Japan. Int J Mol Sci, 2015, 16(2): 3434-3440.
37. Pereira SP, Aithal GP, Ragunath K, et al. Safety and long term efficacy of porfimer sodium photodynamic therapy in locally advanced biliary tract carcinoma. Photodiagnosis Photodyn Ther, 2012, 9(4): 287-292.
38. Smith I, Kahaleh M. Biliary tumor ablation with photodynamic therapy and radiofrequency ablation. Gastrointest Endosc Clin N Am, 2015, 25(4): 793-804.
39. 汪昕, 郑建伟, 邹声泉. 光动力疗法在抗肿瘤血管方面的应用. 临床外科杂志, 2007, 15(4): 277-278.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of photodynamic therapy in palliative treatment of unresectable hilar cholangiocarcinoma

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