Photodynamic therapy combined with a radiation-emitting metallic stent for extrahepatic cholangiocarcinoma: a first-in-human case report.

BACKGROUND: Extrahepatic cholangiocarcinoma (eCCA) carries a dismal prognosis, and the majority of patients present with unresectable disease at diagnosis. Photodynamic therapy (PDT) and radiation-emitting metallic stents (REMS) have each demonstrated palliative benefit in malignant biliary obstruction; however, their sequential combination has never previously been reported in humans. We describe herein the first-in-human application of this combined locoregional approach. CASE DESCRIPTION: A 76-year-old male presented with a 1-month history of progressive fatigue and was diagnosed with eCCA on the basis of contrast-enhanced computed tomography (CT) and biliary biopsy. In view of his poor performance status [Eastern Cooperative Oncology Group (ECOG) score of 2] and personal refusal of surgery, he underwent percutaneous transhepatic cholangiodrainage (PTCD), followed by two sequential sessions of PDT and subsequent implantation of an iodine-125 (125I) seed-loaded REMS. At 6-month follow-up, the patient's ECOG performance status had improved to 0, liver function tests had been normalized, serum carbohydrate antigen 19-9 (CA19-9) had decreased from 57.90 to 13.6 U/mL (within the normal reference range), and imaging demonstrated tumor regression with maintained stent patency. CONCLUSIONS: This case provides the first proof-of-concept for PDT combined with REMS implantation as a unified locoregional strategy for unresectable eCCA. The favorable short-term outcomes support the scientific and clinical rationale for this combined approach and underscore the need for prospective, controlled studies to validate its safety, efficacy, and optimal technical parameters.