Locoregional methods of treatment of patients with extrahepatic bile duct cholangiocarcinoma (review of literature)

The article presents a literature review of studies on the use of local destruction methods (photodynamic therapy and radiofrequency ablation) in the treatment of patients with unresectable extrahepatic cholangiocarcinoma. Currently, many studies have been published on the assessment of photodynamic therapy in the treatment of patients of this category. Radiofrequency ablation in tumors of extrahepatic bile ducts has been used relatively recently, but, according to available data, it may represent an alternative to photodynamic therapy. The article discusses the mechanism of action, the method of photodynamic therapy and radiofrequency ablation, and presents the results of the largest studies. It is reported that photodynamic therapy is comparable to R1/R2 resection according to the survival results. There is evidence of its successful use as adjuvant and neoadjuvant treatment, the possibility of using photodynamic therapy as a method of local tumor control in patients with unresectable cholangiocarcinoma awaiting liver transplantation. The use of radiofrequency ablation at the first stage before stenting the biliary tract allows to increase the diameter of the bile ducts, increases the stent patency time, as well as the survival orate f patients. In addition, radiofrequency ablation and photodynamic therapy can be successfully applied to occlude previously inserted stents. The advantage of photodynamic therapy is the possibility of using it in weakened patients with hyper bilirubinemia. The advantages of radiofrequency ablation include the lower cost of the procedure, as well as the absence of the need to keep the light regimen. The prospects of using methods of locoregional destruction as part of combined treatment regimens (in combination with systemic or regional chemotherapy) are being studied, which allows achieving the best results.

1. Makarov E. S. i dr. Cancer of the proximal bile ducts. Moscow, Pechatka, 2018:100. (In Russ.).

2. Maystrenko N. A. i dr. Cholangiocellular cancer (features of diagnosis and treatment) // Practical Oncology. 2008;(4):229–236. (In Russ.).

3. Wiedmann M. et al. Neoadjuvant photodynamic therapy as a new approach to treating hilar cholangiocarcinoma: a phase II pilot study // Cancer. 2003;97(11):2783–2790.

4. Witzigmann H. et al. Surgical and palliative management and outcome in 184 patients with hilar cholangiocarcinoma: palliative photodynamic therapy plus stenting is comparable to r1/r2 resection /// Ann Surg. 2006;244(2):230–239.

5. Goenka M. K., Goenka U. Palliation: Hilar cholangiocarcinoma // World J. Hepatol. 2014;39(6):559–569.

6. Farley D. R., Weaver A. L., Nagorney D. M. Natural history of unresected cholangiocarcinoma: patient outcome after noncurative intervention // Mayo Clin Proc. 1995;70(5):425–429.

7. Jarnagin W. R. et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma // Ann Surg. 2001;234(4):507–517.

8. Laptsevich T. P. et al. Photodynamic therapy of malignant tumors: fundamentals, history of development, prospects (review) // Journal of Oncology. 2008;(1):117–138.

9. Pahernik S. A. et al. Distribution and pharmacokinetics of Photofrin in human bile duct cancer // J Photochem Photobiol. 1998;47(1): 58–62.

10. Chan Thi Hai Yen et al. Chlorine-type photosensitizers in tumor PDT // Russian Biotherapeutic Journal. 2009;8(4):99–104.

11. Gerhardt T. et al. Combination of bilateral metal stenting and transstent photodynamic therapy for palliative treatment of hilar cholangiocarcinoma // J Gastroenterol. 2010;48(1):28–32.

12. McCaughan J. S. et al. Photodynamic therapy to treat tumors of the extrahepatic biliary ducts. A case report // Arch Surg. 1991;126(1):111–113.

13. Ortner M. E. et al. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study // Gastroenterology. 2003;125(5):1355–1363.

14. Zoepf T. et al. Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy // Am J Gastroenterol. 2005; 100(11):2426–2430.

15. Pereira S. et al. P. PHOTOSTENT-02: porfimer sodium photodynamic therapy plus stentingversus stenting alone in patients with locally advanced or metastatic biliary tract cancer // ESMO Open. 2018;3(5).

16. Moole H. et al. Success of photodynamic therapy in palliating patients with nonresectable cholangiocarcinoma: A systematic review and metaanalysis // World J Gastroenterol. 2017;32(6):1278–1288.

17. Höblinger A. et al. Feasibility and safety of long-term photodynamic therapy (PDT) in the palliative treatment of patients with hilar cholangiocarcinoma // Eur J Med Res. 2011;16(9):391–395.

18. Cheon Y. K. et al. Longterm outcome of photodynamic therapy compared with biliary stenting alone in patients with advanced hilar cholangiocarcinoma // HPB (Oxford). 2012;14(3):185–193.

19. Prasad G. A. et al. Factors associated with increased survival after photodynamic therapy for cholangiocarcinoma // Clin Gastroenterol Hepatol. 2007;5(6):743–748.

20. Talreja J. P. et al. Photodynamic therapy for unresectable cholangiocarcinoma: contribution of single operator cholangioscopy for targeted treatment // Photochem Photobiol Sci. 2011;10(7):1233–1238.

21. Wagner A. et al. Temoporfin improves efficacy of photodynamic therapy in advanced biliary tract carcinoma: A multicenter prospective phase II study// Hepatology. 2015;62(5):1456–1465.

22. Hong M. J. et al. Long-term outcome of photodynamic therapy with systemic chemotherapy compared to photodynamic therapy alone in patients with advanced hilar cholangiocarcinoma // Gut Liver. 2014;8(3):318–323.

23. Wentrup R. et al. Photodynamic Therapy Plus Chemotherapy Compared with Photodynamic Therapy Alone in Hilar Nonresectable Cholangiocarcinoma // Gut Liver. 2016;10(3):470–475.

24. Hauge T. et al. Randomised controlled trial of temoporfin photodynamic therapy plus chemotherapy in nonresectable biliary carcinoma – PCS Nordic study // Photodiagnosis Photodyn Ther. 2016;13:330–333.

25. Granov D. A. i dr. Combination of methods of regional therapy in the treatment of inoperable Klatskin tumor // High-tech medicine. 2020;7(4):8–16. (In Russ.).

26. Nanashima A. et al. Adjuvant photodynamic therapy for bile duct carcinoma after surgery: a preliminary study // J Gastroenterol. 2004; 39(11):1095–1101.

27. Cosgrove N. D. et al. Photodynamic therapy provides local control of cholangiocarcinoma in patients awaiting liver transplantation // Am J Transplant. 2014;14( 2):466–71.

28. Schmidt A. et al. Short-term effects and adverse events of endoscopically applied radiofrequency ablation appear to be comparable with photodynamic therapy in hilar cholangiocarcinoma // United European Gastroenterol J. 2016.;4(4):570–579.

29. Strand D. S. et al. ERCP-directed radiofrequency ablation and photodynamic therapy are associated with comparable survival in the treatment of unresectable cholangiocarcinoma // Gastrointest Endosc. 2014;80(5):794–804.

30. Alvarez-Sánchez M. V., Napoléon B. Review of endoscopic radiofrequency in biliopancreatic tumours with emphasis on clinical benefits, controversies and safety // World J Gastroenterol. 2016;22(37) :8257–8270.

31. Steel A. W. et al. Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction // Gastrointest Endosc. 2011;73:149–153.

32. Yang J. et al. Efficacy and safety of endoscopic radiofrequency ablation for unresectable extrahepatic cholangiocarcinoma: a randomized trial // Endoscopy. 2018;50:751–760.

33. Zheng X. et al. Endoscopic radiofrequency ablation may be preferable in the management of malignant biliary obstruction: A systematic review and meta-analysis // Journal of Digestive Diseases. 2016;17:716–724.

34. Sofi A. A. et al. Radiofrequency ablation combined with biliary stent placement versus stent placement alone for malignant biliary strictures: a systematic review and meta-analysis // Gastrointest Endosc. 2018;87:944–951.

35. Wang Y. et al. Percutaneous intraductal radiofrequency ablation in the management of unresectable Bismuth types III and IV hilar cholangiocarcinoma // Oncotarget. 2016;7(33):53911–53920.

36. Wu T. et al. Percutaneous Intraluminal Radiofrequency Ablation for Malignant Extrahepatic Biliary Obstruction: A Safe and Feasible Method // Dig Dis Sci. 2015;60(7):2158–2163.

37. Pozsa´r J. et al. Intraductal radiofrequency ablation can restore patency of occluded biliary selfexpanding metal stents // Z Gastroenterol. 2011;49:70.

38. Kadayifci A. et al. Radiofrequency ablation for the management of occluded biliary metal stents // Endoscopy. 2016;48:1096.

39. Xia N. et al. Percutaneous intraductal radiofrequency ablation for treatment of biliary stent occlusion: A preliminary result // World J Gastroenterol. 2017;23(10):1851–1856.