Cholangiocarcinoma is, in most cases, rapidly fatal. Curative resection can only be offered to approximately 10% of patients. Even after seemingly curative resection, recurrence frequently occurs.
Adjuvant chemotherapy and/or
radiotherapy do not reduce the recurrence rate after resection. In the palliative setting, endoscopic or percutaneous biliary drainage is performed to relieve
jaundice; however, poor results have been obtained in patients with
tumors involving the intrahepatic bile ducts. Biliary drainage alleviates
jaundice, but there is no evidence that it prolongs life. Palliative
chemotherapy and/or
radiotherapy have not been proven to prolong life and relieve
jaundice.
Photodynamic therapy (
PDT) is a relatively new local, minimally invasive procedure that can be used to treat
cholangiocarcinoma.
PDT uses the physical properties of light-absorbing molecules, so-called
photosensitizers, which accumulate within proliferating cells. Activation of the
photosensitizer by a non-thermal
laser leads to selective photochemical destruction of
tumors. In a randomized trial of patients with nonresectable
cholangiocarcinoma,
PDT prolonged survival time, improved
cholestasis and quality of life considerably, and had a favorable side-effect profile. A second randomized trial confirmed the beneficial effect of
PDT. For the time being,
PDT is recommended for patients with nonresectable disease. The role of
PDT before and after surgical resection needs to be assessed.