Randomised controlled trial of temoporfin photodynamic therapy plus chemotherapy in nonresectable biliary carcinoma--PCS Nordic study.

BACKGROUND: Photodynamic therapy (PDT) in combination with stent have shown promising results in the treatment of biliary tract cancer (BTC) in patients not suitable for surgery. Chemotherapy has been shown to improve survival in patients with local advanced and metastatic BTC. MATERIAL AND METHODS: In the current randomized trial the combination of chemotherapy and stent with and without temoporfin (Foscan) photodynamic therapy (PDT), with a primary endpoint on feasibility and safety, has been performed. Ten patients in each group. RESULTS: No serious, acute procedure-related complication related to PDT or the treatment combination was seen. The number of patients with cholangitis was equal in both groups. In the PDT group--arm A--two patients had cutaneous erythema after sun exposition, one of them with a localized blister. No neutropenic infection was seen. Quality of Life (QoL) was similar in both treatment groups. Progression free survival was numerically longer in the PDT group. CONCLUSION: The treatment combination was feasible. There was no serious complication related to PDT or the treatment combination. Number of cholangitis was equal in both groups, two abscesses were observed in the PDT group. Progression free survival was numerically longer in the PDT group.

Dynamic first pass 3D EPI of the prostate: accuracy in tumor location.

PURPOSE: To evaluate the potential of dynamic contrast enhanced (DCE) 3D EPI in the location of prostate cancer. MATERIAL AND METHODS: A DCE 3D EPI scan was included in the magnetic resonance imaging protocol for prostate examination. Twenty-eight patients who subsequently underwent radical prostatectomy were included in the study. T2-weighted (T2W) Turbo Spin Echo (TSE) images were initially evaluated by two radiologists. Parametric images reflecting contrast enhancement were added and new evaluations performed. The results were compared with histology from resected specimens. Accuracies and interobserver agreements were calculated. RESULTS: Interobserver agreement was Kw =49+/-3% for the T2W technique and Kw=30+/-3% for the combined techniques. No statistically significant advantages were found for location of tumor in the prostate or in the seminal vesicles by adding the DCE information. CONCLUSION: DCE 3D EPI did not improve tumor location compared with that of T2W TSE images. Further investigation is needed on how best to exploit the DCE technique.

Pancreaticobiliary diseases. Comparison of 2D single-shot turbo spin-echo MR cholangiopancreatography with endoscopic retrograde cholangiopancreatography.

PURPOSE: To compare the diagnostic value of MR cholangiopancreatography (MRCP) to that of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of various obstructive and nonobstructive pancreaticobiliary diseases. MATERIAL AND METHODS: We retrospectively reviewed 153 patients who had undergone both MRCP and ERCP Breath-hold, heavily T2-weighted images using 2D single-shot turbo spin-echo technique were obtained. MRCP and ERCP results were correlated with the final clinical diagnoses. Accuracy of MRCP and ERCP in the diagnosis of pancreaticobiliary diseases, detecting the cause and site of biliary obstruction, if present, and distinguishing malignant from benign cause of obstruction were compared. RESULTS: Success rates of MRCP and ERCP were 98.7% and 89.5%, respectively. The accuracy of MRCP and ERCP in detecting the site of biliary obstruction was 89.7% and 96.2%, and in detecting the cause of biliary obstruction 69.2% and 71.8%, respectively. The sensitivity, specificity and likelihood ratios for positive and negative tests for MRCP and ERCP in distinguishing malignant biliary obstruction from benign causes were 86.4%, 82.4%, 4.9, 0.2 and 88.6%, 94.1%, 15.1, 0.1, respectively. Concordance between the two tests was 91% (kappa coefficient 0.82, standard error of kappa 0.113, p<0.001). In the group of nonobstructive biliary diseases, accuracy of MRCP and ERCP in detecting cholecystolithiasis were 100% and 73.7%, and in detecting pancreatitis 57% and 14%, respectively. CONCLUSION: 2D single-shot turbo spin-echo MRCP can be performed as a complement to ERCP and can replace ERCP in high-risk patients and in case of unsuccessful cannulation.