Z Gastroenterol 2013; 51 - A6
DOI: 10.1055/s-0033-1347381

A multi-center retrospective study of photodynamic therapy with polyhematoporphyrin for malignant biliary obstruction: results of 76 consecutive applications

W Dolak 1, B Hellmich 2, M Fleischer 3, I Hinterberger 4, L Booz 1, M Wasilewski 2, B Stadler 3, W Plieschnegger 4, F Siebert 4, P Knoflach 3, M Gschwantler 2, M Trauner 1, A Püspök 1
  • 1Medical University Vienna, Internal Medicine III, Gastroenterology and Hepatology, Vienna, Austria
  • 2Wilhelminenspital, Department of Internal Medicine IV, Vienna, Austria
  • 3Klinikum Wels-Grieskirchen, Department of Internal Medicine I, Wels, Austria
  • 4Barmherzige Brüder St. Veit an der Glan, Department of Internal Medicine, St. Veit an der Glan, Austria

Introduction: Photodynamic therapy (PDT) is a treatment modality for malignant biliary obstruction. The aim of the present study was to retrospectively analyze the experience with PDT using polyhematoporphyrin as a photosensitizer at different Austrian referral centers for biliary endoscopy.

Methods: At the participating institutions charts of PDT patients were screened for their underlying diseases, anti-tumor co-therapies, interventional complications, adverse events within 30 days post PDT and follow-up.

Results: 47 patients (34 male, 13 female, median age 70 years, range 46 to 86 years) underwent a total of 76 PDT applications at 4 referral centers in Austria. Polyhematoporphyrin was used as a photosensitizer in all cases (2 mg/kg body weight). The underlying conditions included 41 Klatskin tumors, 4 cases of metastatic colorectal cancer (mCRC) and 2 cases of distal cholangiocarcinoma (CCa). Prior tumor treatment included chemotherapy in 12 cases, liver surgery in 5 cases, radiofrequency ablation in 2 cases and 1 case each of external radiotherapy, ethanol instillation and selective internal radiotherapy. PDT could be performed without any complication in all patients. Within 30 days after PDT the following adverse events were recorded: 13 cases of cholangitis, 2 cases of E. coli sepsis and 1 case each of non-ST-elevated myocardial infarction, transfusion dependent anemia, Clostridium difficile colitis and acute renal failure. 30-day and 90-day mortality (referring to the first PDT procedure) were 2% and 12%, respectively. The median survival after PDT was 15.1 months (95% CI 11.6 – 18.5 months).

Conclusion: PDT using polyhematoporphyrin as a photosensitizer proved to be feasible and safe in this retrospective study. The number of adverse events within 30 days after PDT (including the rate of cholangitis), mortality rates and survival time were comparable to previous publications on PDT with different photosensitizers. PDT seems to be a valuable therapeutic option for patients suffering from malignant biliary obstruction.