Photodynamic therapy for perihilar cholangiocarcinoma

Cholangiocarcinoma of the biliary hilum is an uncommon disease but increasing in incidence. Patients affected by this frequently fatal disease often succumb to complications including liver failure and cholangitis secondary to progressive biliary obstruction. The current standard of care in the United States is chemotherapy with gemcitabine and cisplatin that offers a survival benefit just in excess of three months. Endoscopic ablation with photodynamic therapy (PDT) has been used effectively to palliate patients and is considered the standard of care in some European countries. PDT has been demonstrated to resolve jaundice, improve quality of life, and prolong life with favorable outcomes when compared to other treatment options. This has led to other novel applications including using PDT as part of a neoadjuvant protocol to downstage tumors. A multicenter trial is currently being performed to study the role of PDT compared to chemotherapy for perihilar cholangiocarcinoma.