Navigation Links
Combined stenting and photodynamic therapy improves survival in late stage liver cancer patients

Bethesda, MD (March 11, 2008) A combined therapeutic approach of stenting and photodynamic therapy may improve survival rates for patients suffering from advanced liver bile duct cancer, according to a study published this month in Clinical Gastroenterology and Hepatology, the official journal of the American Gastroenterological Association (AGA) Institute.

Researchers in the study found that while stenting can help reinforce the bile duct to increase liver functionality, the light therapy assisted in attacking the cancer cells directly. The combined therapy led to significant reductions in mortality rates in the year following treatment, compared with stenting treatment alone.

This is a very aggressive disease that were fighting, as most patients are diagnosed when we can only offer palliative care, said Michel Kahaleh, MD, of the University of Virginia and lead investigator of the study. What we found in this study is that combining therapies that fight the disease and help improve liver functionality can help extend the survival rates for these patients.

In this study, 48 patients were treated for advanced cholangiocarcinoma over a five year period. Nineteen were treated with photodynamic therapy (PDT) and stents, while 29 patients were treated with biliary stents alone. In the group receiving combined therapy, the photodynamic agent (porfimer sodium, a commonly used agent) was injected and activated, and plastic stents were inserted. PDT was repeated every three months, at which time all stents were replaced. If the team found blockages or shifting, stents were exchanged earlier to maintain optimal decompression.

The group treated with stenting and PDT showed improved survival rates compared to the stent-only group (16.2 months vs. 7.4 months). Mortality in the PDT group at three, six and 12 months was 0, 16 and 56 percent respectively, while the corresponding mortality in the stent group was 28, 52 and 82 percent respectively. The difference between the two groups was significant at three and six months, but not at 12 months. Upon further analysis, the team found that only the number of ERCP procedures and number of PDT sessions were significant in determining survival. In both groups, serum bilirubin was successfully reduced.

PDT is an evolving therapy that involves administering a photosensitizing agent and activating it using light illumination of a specific wavelength, which kills the targeted cells. PDT is thought to destroy cancer and neovascular cells and reduce tumor mass, and in earlier prospective trials, PDT was associated with a significant reduction in bilirubin (a red blood cell byproduct excreted in liver bile) and increased survival compared to historical data.

While we are pleased with the results of the study, we need to better understand if the effect is attributable primarily to the photodynamic therapy or to the number of ERCP sessions, said Dr. Kahaleh.

Adverse events specific to PDT included three patients with skin phototoxicity requiring topical therapy. Complications in the stent-only group included patients developing cholangitis after therapy with two patients dying as a consequence. Post ERCP pancreatitis was observed in four patients and duodenal perforation in one. Other adverse events in the stent group included a liver abscess (1), perforation (1) and non-St elevation myocardial infarction, or heart attack (2). In the PDT group, seven patients (37 percent) developed cholangitis treated with antibiotics alone. No patients had contraindications to photodynamic therapy contrast agents, and all patients received prophylactic antibiotics prior to the procedures.

Analyses were performed to detect predictors of survival, including MELD score (Model for End-stage Liver Disease, the extent of the disease), age, treatment by chemotherapy or radiation, and number of ERCP procedures and PDT sessions. Successful therapy was defined by relief of cholangitis (infection caused by biliary blockage), jaundice and pruritis (itching) with a decrease of bilirubin to less than 75 percent of the pre-treatment value within 30 days.

Cholangiocarcinoma (cancer of the livers bile ducts) is the second most common liver cancer and is associated with significant morbidity and mortality, diagnosed in about 2,000 new cases every year. The majority of patients (almost 80 percent) are diagnosed when surgery is no longer an option due to the extent of the disease, with most surviving up to three months without intervention or four to six months with decompression treatment, which helps maintain the function of the liver by opening the bile ducts.

Treatment for the disease has evolved from surgery to endoscopic management, which involves placing a plastic stent in the bile duct to manage flow and control the cancerous growth (ERCP). It has become a standard of care to manage jaundice and prevent cholestasis (blockage of the bile duct), with less morbidity and mortality than that associated with surgery. However, the efficacy of stenting is limited because they cannot independently attack the tumor cells.


Contact: Aimee Frank
American Gastroenterological Association

Related medicine news :

1. Study Finds New Version of QIAGENs HPV Test for Developing Countries Could Reduce Risk of Cervical Cancer by More than Half When Combined With Appropriate Treatment
2. Phase III Trial of VELCADE(R) (Bortezomib) for Injection Showed Dramatic Fourfold Increase in Complete Remission Rates When Combined With the Most Commonly Used U.S. Regimen in Front-Line Multiple Myeloma
3. Combined Boards Provide Better Care to More Clients More Efficiently
4. Combined HRT increases risk of lobular breast cancer fourfold after just 3 years of use
5. Combined radiation seed, chemotherapy wafer implants show promise in treating cancerous brain tumors
6. AT4 wireless and Ekahau Partner to Deploy Combined Asset and Staff Tracking Solution for Hospitals
7. Real-World Studies of Carotid Artery Stenting Demonstrate Results Comparable to Guidelines for Patients Treated With Surgery
8. Research sheds light on carotid artery stenting risk in elderly
9. Vascular surgeons ask, whats next for carotid artery stenting?
10. Vision restoration therapy shown to improve brain activity in brain injured patients
11. HIV therapy in pregnancy-data support WHO recommendations
Post Your Comments:
(Date:11/29/2015)... ... November 29, 2015 , ... While conventional walkers afford considerable help with mobility, ... exercise weights. Fortunately, an inventor from Uniontown, Pa., has found a way to address ... benefits of a standard walker to improve the user’s quality of life. To begin ...
(Date:11/28/2015)... (PRWEB) , ... November 28, 2015 , ... ... exchange technology and teleradiology services, has added Chris Hafey and Claude Hooton to ... at the Radiological Society of North America (RSNA) 2015 Annual Meeting and continues ...
(Date:11/27/2015)... ... November 28, 2015 , ... There is only one major question ... from last year? , This question has not been an easy question to answer. ... retirement age and the younger workforce don’t share the same discipline around working long ...
(Date:11/27/2015)... Raleigh, NC (PRWEB) , ... November 27, 2015 , ... ... most effective ways to treat it. Surviving Mesothelioma has just posted the findings ... Researchers at University Hospital Zurich analyzed the cases of 136 mesothelioma patients who were ...
(Date:11/27/2015)... ... November 27, 2015 , ... ProSidebar: Fashion is a set of ... With ProSidebar: Fasion, video editors can easily add an informative sidebar to any FCPX ... Utilize presets featuring self-animating drop zones, lines, bars, and text with the ease ...
Breaking Medicine News(10 mins):
(Date:11/29/2015)... -- Strengthening its leadership in connected healthcare informatics, Royal ... IntelliSpace Portal 8.0 , the latest edition of its ... radiologists detect, diagnose and follow-up on treatment of diseases. ... America Annual Meeting (RSNA) in Chicago, ... changing demands in radiology that result from an increasing ...
(Date:11/29/2015)... --  Royal Philips  (NYSE: PHG, AEX: PHIA) revealed a ... Radiological Society of North America Annual Meeting (RSNA), beginning ... Chicago . Visitors to the Philips ... of integrated Diagnostic Imaging, Clinical Informatics, Image Guided Therapy ... workflow and create a superior patient experience. ...
(Date:11/29/2015)... CHICAGO and NUREMBERG, Germany ... annual meeting, innovation leader Ziehm Imaging invites attendees to ... technology on the market. The highlight on display is ... with flat-panel technology that provides a 16 cm edge ... Ziehm Vision RFD Hybrid Edition, the first fully motorized ...
Breaking Medicine Technology: