Photodynamic Therapy Promising in Pancreatic Cancer

March 19, 2002

NEW YORK (MedscapeWire) Mar 20 - Photodynamic therapy in otherwise unresectable pancreatic cancer allows improved outcome with acceptable morbidity, according to results of a study reported in the April issue of Gut.

"Few pancreatic cancers are suitable for surgery and few respond to chemoradiation," write S.G. Bown, from London's Royal Free and University College Medical School, and colleagues.

Using light in conjunction with a photosensitizing agent, photodynamic therapy produces somewhat selective tumor necrosis with minimal effects on surrounding normal tissue.

In this phase I study, 16 patients with inoperable adenocarcinomas, 2.5-6 cm in diameter, involving the head of the pancreas, all had obstructive jaundice relieved by biliary stenting. Three days after photosensitization with 0.15 mg/kg mesotetrahydroxyphenyl chlorin intravenously, laser fibers positioned under CT guidance delivered light to the cancer percutaneously. Three patients had subsequent chemotherapy.

After treatment, all patients had substantial tumor necrosis on scans. Patients were able to start eating and drinking within 48 hours, and 14 were discharged within 10 days. In 10 of 11 patients with a Karnofsky performance status of 100 before treatment, it returned to 100 at one month after treatment. All patients were able to spend at least some time at home with their families, and only three were hospitalized for >20% of their survival time.

There were no deaths related to treatment. One-year survival was 44%, and median survival after photodynamic therapy was 9.5 months (range 4-30). Two patients with tumor involving the gastroduodenal artery had significant gastrointestinal bleeding controlled without surgery, and three patients developed duodenal obstruction during follow-up that may have been treatment-related.

"Photodynamic therapy can produce necrosis in pancreatic cancers with an acceptable morbidity, although care is required for tumors invading the duodenal wall or involving the gastroduodenal artery," the authors write. "Further studies are indicated to assess its influence on the course of the disease, alone or in combination with chemoradiation."

Gut. 2002;50(4):549-557

Reviewed by Gary D. Vogin, MD

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