Abstract

Background: advantages of endobiliary photodynamic therapy (PDT) described in the first part of review, namely: the safety of the intervention, the predictability and reproducibility of the effect, the absence of rough scarring of bile ducts, the possibility of repeating of procedures, affordability financially and economically - make this technology preferred among others locoregional effects in patients with hilus cholangiocarcinoma.

Aim: was to get a clinical specialist' view of endobiliary PDT as the perspective method: to describe dynamics of photosensitizer (PS) accumulation by tumor in vivo, to describe tools for delivering light into the lumen of bile ducts and intervention technique, to describe characteristics of light dosimetry, and to analyze immediate and long-term results of intra-duct photo exposure.

Material and methods: 66 domestic and foreign literary sources were analyzed.

Conclusion: endobiliary photodynamic therapy is a safe and effective method of locoregional treatment of patients with hilar cholangiocarcinoma, which significantly increases the duration and improves the quality of life of previously considered incurable patients.

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Abstract

Aim: was to identify possibilities of MRI with contrast enhancement in assessment of differentiation

grade of liver metastases of neuroendocrine tumors (NET).

Materials and methods: 103 patents with morphologically confirmed liver metastases of NET were enrolled in the study. All patients underwent abdominal contrast-enhanced MRI. A total of 241 lesions were assessed. In the region of interest, which corresponded to the rounded locus in solid port-contrast T1-weighted images. Obtained data were compared in groups of different grade of tumor tissues differentiation; the correlation of MRI parameters with Ki67 was also evaluated.

Results: study demonstrated that Grade (G) 1 of NET metastases are characterized by a more active accumulation of MR contrast agent (MRCA) and a higher SI in arterial (p=0,0002, p=0,0003, respectively) and venous (p=0,0003, p=0,0001, respectively) phases of contrast enhancement compared with G2 and G3. Also, well-differentiated NETs had higher SI in the delayed phase of contrast enhancement (p = 0,0038) and the more rapid wash-out of MRCA (p=0,0314). The Ki67 index inversely correlated with the degree of MRCA accumulation in arterial and venous phases of MRI with contrast enhancement. Revealed consistency may be useful for guided tissue sampling in biopsy and identification of the grade "migration" phenomenon, which will allow competently and timely choose/change treatment modality.

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Abstract

Background: hilar cholangiocarcinoma (Klatskin tumor) is a rare and severe hepatobiliary malignancy of proximal bile ducts with dismal prognosis, slow periductal growth, late metastatic spread and is mostly fatal due to local complications. Surgical resection is considered to be the only curative method to the date, but its results aren't satisfactory as the majority of patients (70-80%) aren't suitable surgical candidates due to a large tumor extent in local hilar area. Moreover, local recurrence rate reaches 80% over 7 years. Thus endobiliary loco-regional technologies have been proposed, one of which is a photodynamic therapy (PDT).

Aim: was to provide provide a preclinical rationale of PDT in Klatskin tumor patients: to describe principles and mechanisms of the method and summary experimental studies data; this can prepare the reader for the second part of the review, which is based on the analysis of clinical studies and can give practical orientation.

Material and methods: 63 domestic and foreign literature sources were analyzed.

Conclusion: endobiliary photodynamic therapy showed its safety and efficacy in many experimental studies and can successfully be applied in clinical practice. 

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Article exists only in Russian.