Neoadjuvant photodynamic therapy before curative resection of proximal bile duct carcinoma

Background: Hilar bile duct carcinoma has an 80% probability of local recurrence after curative resection, which might be reduced if neoadjuvant photodynamic therapy is feasible. Case and Treatment: After intravenous injection of sodium porfimer we treated an adenocarcinoma of the proximal common bile duct (T2 N0 M0, Bismuth type II) in a 72-year-old man with red laser light (applied from the lumen at a dose 250 Joules/cm(2)), and the adjacent right and left hepatic and common bile duct at a dose of 125 Joules/cm(2). After 23 days the tumor was completely resected (adenocarcinoma pT2 pN0; G2), Results: In the lumenal, 4-mm-thick layer the bile duct specimen exhibited complete tumor necrosis with pigmentation of photodegraded porfimer and no viable; tumor cells, while in the outer layer of the wall (at 5-8-mm depth) viable cancer cell nests without degraded porfimer were seen, The bile duct tissue showed little: damage. Eighteen months after surgery, neither tumor recurrence nor stricture formation was found at the pretreated bilioenteric anastomoses. Conclusions: a) Photodynamic therapy with sodium porfimer seems to be confined to the superficial 4-mm layer of bile duct cancer. b) Neoadjuvant photodynam ic therapy is feasible for hilar bile duct carcinoma.