4 juli 2012: vanaf volgende week wordt de nanoknife - IRE - Irreversible electroporation in gebruik genomen in een Nederlands academisch ziekenhuis. Wie denkt daarvoor in aanmerking te komen kan bij ons via redactie@kanker-actueel.nl een rechtstreeks e-mailadres opvragen van de artsen die daarmee gaan werken. Lees wel eerst de algemene informatie over de beperkingen van de nanoknife aub om teleurstellingen te voorkomen.

In Italië loopt een fase II studie bij galwegkanker met de nanoknife - IRE - Irreversible electroporation

Het studie protocol vindt u hier: Pilot Study of Irreversible Electroporation (IRE) to Treat Metastatic Liver Cancer & Cholangiocarcinoma

6 februari 2010: Z Gastroenterol. 2010 Jan;48(1):28-32. Epub 2010 Jan 13.

Wanneer stents worden geplaatst in combinatie met PDT - Photo Dynamische Therapie (licht) dan blijkt de mediane overlevingstijd voor patienten met een inoperabele galwegkanker verlengd te kunnen worden. Dit bljikt uit een kleine gerandomiseerde studie. Al in 2005 toonde een andere gerandomiseerde studie aan dat PDT naast het plaatsen van stents effectief is en de mediane overlevingstijd sterk kan verlengen. De mediane overlevingstijd ging van 7 maanden zonder PDT naar 21 maanden met PDT. Zie hier het meest recente abstract en daaronder het abstract uit 2005.

Z Gastroenterol. 2010 Jan;48(1):28-32. Epub 2010 Jan 13.

Combination of bilateral metal stenting and trans-stent photodynamic therapy for palliative treatment of hilar cholangiocarcinoma.

Gerhardt T, Rings D, Höblinger A, Heller J, Sauerbruch T, Schepke M.

Department of Internal Medicine I, University Hospital, Bonn, Germany. tm.gerhardt@web.de

Endoscopic biliary drainage is the mainstay of palliative treatment in patients with unresectable malignant hilar biliary obstruction. While self-expandable metal stents have shown significant advantages in distal tumors, bilateral hilar stenting is technically demanding. Moreover, ingrowth is a significant problem in uncovered stents. We evaluated the feasibility and efficacy of endoscopic bilateral JoStent SelfX deployment in patients with proximal malignant biliary obstruction in combination with photodynamic therapy (PDT) and/or chemotherapy. Twenty-one consecutive patients with malignant hilar biliary strictures were treated with transpapillary bilateral insertion of JoStentSelfX metal stents. Additional PDT was applied in 8 patients (PDT plus chemotherapy n = 4, only PDT n = 4). Solely chemotherapy was performed in 5 patients. Mean (+/- SD) stent patency was 173.9 +/- 201.8 days. The median estimated survival was 12.3 months (95 % CI: 8.5; 15.9). PDT was safely and efficaciously performed after endoscopic stent deployment (1.8 +/- 1.1 sessions/patient). There was a trend towards a longer stent patency in patients receiving additional therapy (202.2 +/- 197.6 vs. 128 vs. 213.2 days; p = 0.38). Furthermore, we observed a significantly longer survival in this cohort (16.5 [12.2; 20.1] vs. 12.3 [1.9; 8.5] months, p < 0.005). Additional therapy had no significant impact on cumulative hospitalization time (16.3 +/- 15.8 vs. 14.4 +/- 22.5 days; p = 0.54). Bilateral insertion of Jostent SelfX in patients with proximal cholangiocarcinoma is feasible and effective and can be safely combined with trans-stent photodynamic therapy.

PMID: 20072993 [PubMed - in process]

01/01 2006: Bron: Am J Gastroenterol 2005;100:2426-2430

PDT = Photo Dynamische Therapie als aanvullende palliatieve behandeling bij patiënten met inoperabele galwegenkanker toont hoog significante verbetering van mediane overlevingstijd. In elke groep werden 16 patiënten behandeld. In de groep die aanvullend PDT kreeg naast het plaatsen van een stent bleek de mediane overlevingstijd 21 maanden te zijn en een veel betere kwaliteit van leven. In de groep die geen PDT kreeg als aanvulling op het plaatsen van een stent bleek de mediane overlevingstijd 7 maanden te zijn. Dit publiceren onderzoekers van de universiteit van Essen - Duitsland deze week als resultaten uit een gerandomiseerde studie met totaal 32 patiënten met inoperabele galwegenkanker. Deze week hopen we de berichtgeving via Medscape over deze studie voor u te vertalen.

Palliative Photodynamic Therapy Improves Survival in Bile Duct Cancer

NEW YORK (Reuters Health) Dec 23 - In patients with nonresectable bile duct cancer, photodynamic therapy (PDT) designed to reduce bile duct stenosis improves quality of life and substantially prolongs survival time, physicians in Germany report.
Preliminary uncontrolled studies of photodynamic therapy have demonstrated "astonishingly good results," Dr. Thomas Zoepf and his associates note in their paper in the American Journal of Gastroenterology for November.

Dr. Zoepf, from University Hospital Essen, and his team conducted a prospective trial in which patients with advanced nonresectable bile duct cancer were randomly assigned to an endoprosthesis alone or an endoprosthesis plus PDT (16 patients in each group). PDT involved IV administration of the hematoporphyrin derivative Photosan 3 (SeeLab, Wesselburenerkoog, Germany), followed 2 days later with laser irradiation administered either through transpapillary access or percutaneously.

"Four weeks after initial PDT, most PDT-patients showed an almost complete elimination of bile duct stenosis in the treated area as demonstrated by cholangiography," the authors report.
Median survival was 21 months in the PDT group versus 7 months in the control group (p = 0.01). The investigators also note that among the eight patients in the PDT group who initially required percutaneous transhepatic drainage, four could be converted to transpapillary access, representing a "significant improvement in the quality of life."

There were four serious infections in the PDT group as opposed to one in the control group. However, these occurred in the early phase of the study when only 3 days of antibiotics was given; there were no more serious infections once coverage was increased to 14 days.

Dr. Zoepf's group recommends larger clinical trials to confirm their results. Moreover, they add, "as hematoporphyrins also have radiosensitizing properties, a combination of PDT and radiotherapy may further improve tumor response and survival time in future."

Am J Gastroenterol 2005;100:2426-2430.

galwegkanker, nanoknife, Photo Dynamische Therapie, PDT