[Therapy of pancreatic and bile duct tumors: value of radiotherapy and photodynamic therapy]

Prognosis of pancreatic cancer and bile duct cancer is extraordinary poor. Despite of the improvement in diagnostic procedures and the development of more radical resectional procedures prolongation of survival could not have been achieved yet. At the time of diagnosis only 20-30% of patients are suitable for resection, thus the value of non resectional methods for palliation has to be determined. Despite of numerous efforts to increase the local radiation dosage by means of distinguished radiation techniques none of these procedures could achieve an unequivocal prolongation of survival. After promising preliminary results of intraoperative radiotherapy (IORT) in pancreatic cancer following studies could not show a survival benefit for IORT allone or in combination with extracorporal radiotherapy (EBRT). EBRT is indicated at best for local pain control and is limited by the high radiation sensitivity of the adjacent organs. Intracorporal radiotherapy or brachytherapy with iridium 129-labelled wires leeds to local, intraluminal tumour control, but has also no influence on survival time. Up to now, photodynamic therapy (PDT) of pancreatic cancer must be characterized as highly experimental. But PDT can contribute to local tumour control. Preliminary data of photodynamic therapy in bile duct cancer show good results concerning reduction of cholestasis, improvement of life quality and even prolongation of survival time. The value of these preliminary results is being proved at present in controlled studies in comparison to mere endoprosthetic supply at a few centers.