EVALUATING THE ROLE OF PHOTODYNAMIC THERAPY IN THE MANAGEMENT OF PANCREATIC-CANCER

Background and Objective: Cancer of the pancreas constitutes one of the major causes of cancer related death throughout the world. A 5-year survival rate of only 2% and a maximum of 20 months median survival in multi modality treatment studies dealing with the most favorable patients only, has been demonstrated. This review analyzes the principal treatments and available experimental data in view of a clinical application of photodynamic therapy (PDT) for the treatment of pancreatic cancer. Study Design/Materials and Methods: On the basis of published results, we examined the palliation of pancreatic cancer by chemotherapy alone; radiation alone and multimodality schedules (radiation and chemotherapy). Radical tumor resection was examined as attempted curative treatment. Results: In reported therapeutic procedures, palliative or potentially curative, median survival was below 2 years. The GTSG reported survival time increases from 10.9 to 21.0 months when surgery is followed by adjuvant chemotherapy and radiation. This combination postoperatively does not increase mortality, but adds 30% morbidity. Photodynamic therapy has been demonstrated in preclinical studies to have a selective effect on malignant versus the normal pancreas. Conclusion: PDT is highly effective in eliciting the destruction of experimental pancreatic tumors with the lack of significant effect on the normal pancreas. The poor prognosis for patients with this disease, especially those patients with advanced disease, warrants closer examination of PDT for the treatment of pancreatic cancer. (C) 1995 Wiley-Liss, Inc.