The prognosis of patients with an unresectable
bile duct cancer is poor. In 60-70% of patients,
cholangiocarcinoma is located in the hepatic duct bifurcation and known as Klatskin tumour. Surgical resection offers the only chance for 5-year survival, but less than 20% are surgical candidates. Patients with unresectable
cholangiocarcinoma are treated with biliary drains, but commonly die of
liver failure or
cholangitis due to biliary obstruction within 6 to 12 months.
Chemotherapy and/or
radiotherapy have not been evaluated in randomized, controlled trials.
Photodynamic therapy (
PDT) is a new and promising locoregional treatment, the aim of which is to destroy tumour cells selectively.
PDT involves the injection of a
photosensitizer followed by percutaneous or endoscopic direct illumination of the tumour with light of a specific wavelength. In recent non-randomized studies of small numbers of patients with unresectable
cholangiocarcinoma,
PDT induced a decrease in serum
bilirubin levels, improved quality of life and a slightly better survival. Other non-randomized trials failed to show clinical benefits. Recently, the first prospective, randomized controlled study with
PDT in a selected group of non-resectable
cholangiocarcinoma patients was stopped prematurely. The improvement in survival in the
PDT-randomized patients was so impressive that it was considered to be unethical to continue randomization. However, further studies are awaited in unselected patients with unresectable
cholangiocarcinoma before
PDT can be considered as the standard adjuvant
therapy.