Treatment of Non-resectable Bile Duct Cancer with Radiofrequency Ablation or Photodynamic Therapy

NCT ID: NCT05551299

Last Updated: 2025-03-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

258 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-02-10

Study Completion Date

2028-04-30

Brief Summary

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Bile duct cancer is often diagnosed after curative options are no longer available. Stent therapy is used to keep the ducts open and can be combined with photodynamic therapy (PDT) to extend life expectancy. PDT requires an injection of photosensitizer after which light of a particular wavelength is applied endoscopically to kill the cancer cells. Drawbacks include not only high costs and poor availability, but foremost that patients have to avoid direct sunlight for a period of weeks. Radio frequency ablation (RFA) together with stent implantation constitutes an alternative by which the cancer cells are killed through heat, also applied endoscopically. The RFA technology is more widely available and easier to deploy. However, it has not been studied extensively and no randomized trials exist comparing the two methods. This trial will compare survival in patients with a particular bile duct cancer depending on whether they receive PDT or RFA. Moreover, data will be collected on side-effects and quality of life.

Detailed Description

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Klatskin tumours are a form of bile duct cancer. They are generally not diagnosed until quite late and a curative operation is rarely a possibility. Their anatomic location usually results in bile duct obstruction and the aim of therapy is thus to keep the ducts open. This is accomplished through endoscopic retrograde cholangiopancreatography (ERCP) by implanting stents. Stent therapy combined with photodynamic therapy (PDT) extends life expectancy. PDT requires an injection of photosensitizer that is absorbed primarily by the cancer cells. Light of a particular wavelength is then applied with ERCP to kill the cancer cells. Drawbacks include not only high costs and poor availability, but foremost that patients have to avoid direct sunlight for a period of weeks. Radio frequency ablation (RFA) together with stent implantation constitutes an alternative by which the cancer cells are killed through heat applied during ERCP. The RFA technology is more widely available and easier to deploy. However, it has not been studied extensively and no randomized trials exist comparing the two methods. This trial will compare survival in patients with Klatskin tumours depending on whether they receive PDT or RFA. Moreover, data will be collected on side-effects and quality of life.

Conditions

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Hilar Cholangiocarcinoma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Photodynamic therapy (PDT)

The index procedure in all patients at baseline includes stenting, using an endoscopic retrograde cholangio-pancreatography (ERCP) procedure. The Intervention is at least one PDT at baseline according to the clinical routine of the trial site.

Group Type EXPERIMENTAL

Photosensitizer

Intervention Type DRUG

A photosensitizer, which is absorbed preferentially by tumour cells, is administered 24 - 48 hours prior to PDT. Light of a particular wavelength is then applied during endoscopic retrograde cholangiopancreatography (ERCP) to kill primarily cancer cells locally within the stenosis. Immediately after PDT treatment, new stents are inserted into all treated segments if needed.

Radiofrequency ablation (RFA)

The index procedure in all patients at baseline includes stenting, using an endoscopic retrograde cholangio-pancreatography (ERCP) procedure. The Intervention is at least one RFA at baseline according to the clinical routine of the trial site.

Group Type EXPERIMENTAL

Radiofrequency ablation (RFA)

Intervention Type PROCEDURE

RFA is also carried out as part of an ERCP. The RFA-probe is placed within the tumour stenosis and electrical current is applied. New stents are inserted into all treated segments if needed.

Interventions

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Photosensitizer

A photosensitizer, which is absorbed preferentially by tumour cells, is administered 24 - 48 hours prior to PDT. Light of a particular wavelength is then applied during endoscopic retrograde cholangiopancreatography (ERCP) to kill primarily cancer cells locally within the stenosis. Immediately after PDT treatment, new stents are inserted into all treated segments if needed.

Intervention Type DRUG

Radiofrequency ablation (RFA)

RFA is also carried out as part of an ERCP. The RFA-probe is placed within the tumour stenosis and electrical current is applied. New stents are inserted into all treated segments if needed.

Intervention Type PROCEDURE

Other Intervention Names

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Photodynamic therapy (PDT)

Eligibility Criteria

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Inclusion Criteria

1. Hilar cholangiocarcinoma (cytological or histological confirmation)
2. Surgery is not planned
3. Age ≥ 18 years
4. Written informed consent

Exclusion Criteria

1. Tumour not accessible endoscopically
2. Known hypersensitivity to porphyrins or to any of the other ingredients of the photosensitizer chosen
3. Leukopenia (\< 2000/mm3)
4. Thrombocytopenia (\< 100,000 / mm³)
5. Severe, uncorrected coagulopathy (at the discretion of the physician)
6. Suspected erosion of major blood vessels, because of the risk of life-threatening mass haemorrhage exists
7. Porphyria (clinician's assessment) or other light-exacerbated diseases
8. Severely impaired liver and or kidney function (at the discretion of the physician)
9. Bedridden for more than 50% of the time (similar to ECOG (Eastern Cooperative Oncology Group) grade 3)
10. Planned surgical procedure within the next 30 days
11. Concurrent eye disease that will require a slit lamp examination within the next 30 days
12. Prior radiotherapy within the last four weeks
13. Previous PDT or RFA
14. Planned liver transplantation
15. Fertile women (within two years of their last menstruation) without appropriate contraceptive measures (implanon, injections, oral contraceptives, intrauterine devices, partner with vasectomy) while participating in the trial (participants using a hormone-based method have to be informed of possible effects of the trial medication on contraception)
16. Participation in other interventional trials
17. Patients under legal supervision or guardianship
18. Pregnant or nursing women
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Zentrum für Klinische Studien Leipzig

OTHER

Sponsor Role collaborator

University of Leipzig

OTHER

Sponsor Role lead

Responsible Party

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Albrecht Hoffmeister

Prof. Dr. med.

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Albrecht Hoffmeister, Prof.Dr.med.

Role: PRINCIPAL_INVESTIGATOR

Universitätsklinikum Leipzig; Bereich Gastroenterologie

Locations

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Uniklinik RWTH Aachen, Medizinische Klinik III

Aachen, , Germany

Site Status RECRUITING

Universitätsklinikum Augsburg; III. Med. Klinik

Augsburg, , Germany

Site Status RECRUITING

Vivantes Netzwerk für Gesundheit GmbH, Klinikum Friedrichshain, Innere Medizin/Gastroenterologie

Berlin, , Germany

Site Status NOT_YET_RECRUITING

Universitatsklinikum Bonn, Medizinische Klinik und Poliklinik I

Bonn, , Germany

Site Status RECRUITING

Universitätsklinikum Frankfurt, Medizinische Klinik 1

Frankfurt, , Germany

Site Status NOT_YET_RECRUITING

Universitätsklinikum Freiburg, Medizinische Klinik II, Abteilung Gastroenterologie, Hepatologie, Endokrinologie & lnfektiologie

Freiburg im Breisgau, , Germany

Site Status RECRUITING

Universitätsmedizin Greifswald Klinik für Innere Medizin A

Greifswald, , Germany

Site Status RECRUITING

Site: Martin-Luther-Universitat Halle-Wittenberg, Universitätsklinik und Poliklinik für Innere Medizin I

Halle, , Germany

Site Status RECRUITING

Klinikum Hanau; Klinik für Gastroenterologie, Diabetologie und Infektiologie

Hanau, , Germany

Site Status RECRUITING

KRH Klinikum Siloah, Klinik für Gastroenterologie

Hanover, , Germany

Site Status RECRUITING

Klinikum St. Georg gGmbH; Klinik für Gastroenterologie, Hepatologie, Diabetologie und Endokrinologie

Leipzig, , Germany

Site Status RECRUITING

University Hospital of Leipzig, Department of Gastroenterology

Leipzig, , Germany

Site Status RECRUITING

RKH Kliniken Ludwigsburg- Bietigheim gGmbH, Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Diabetologie und Infektiologie

Ludwigsburg, , Germany

Site Status RECRUITING

Universitätsmedizin Mannheim, II. Medizinische Klinik

Mannheim, , Germany

Site Status WITHDRAWN

Universitätsklinikum Gießen und Marburg GmbH (UKGM); Klinik für Innere Medizin mit den Schwerpunkten Gastroenterologie, Endokrinologie, Stoffwechsel und klinische Infektiologie

Marburg, , Germany

Site Status RECRUITING

Klinikum der LMU München, Medizinische Klinik II, Campus Großhadern

München, , Germany

Site Status RECRUITING

Universitlitsklinikum Munster Medizinische Klinik B (Gastroenterologie, Hepatologie, Endokrinologie, Klinische lnfektiologie)

Münster, , Germany

Site Status RECRUITING

Klinikum Nürnberg Nord; Gastroenterologie/ Endokrinologie

Nuremberg, , Germany

Site Status RECRUITING

Robert-Bosch-Krankenhaus (RBK) Stuttgart; Gastroenterologie, Hepatologie und Endokrinologie

Stuttgart, , Germany

Site Status RECRUITING

Universitätsklinikum Tübingen, Medizinische Klinik I

Tübingen, , Germany

Site Status RECRUITING

Countries

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Germany

Central Contacts

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Albrecht Hoffmeister, Prof.Dr.med.

Role: CONTACT

+49-341-97-12240

Marcus Hollenbach, Dr. med.

Role: CONTACT

+49-341-97-12362

Facility Contacts

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Karim Hamesch, PD Dr.

Role: primary

+49 241 80 80861

Tobias Weber, Dr.

Role: primary

Thomas Brunk, Dr.

Role: primary

Dominik Kaczmarek, Dr.

Role: primary

+49 228 287 -15263

Jörg Trojan, Prof. Dr.

Role: primary

Armin Küllmer, Dr.

Role: primary

Ali Aghdassi, Prof.

Role: primary

Jonas Rosendahl, Prof. Dr.

Role: primary

+49 345 557 2661

Likas Welsch, Dr.

Role: primary

Daniel Vidacek, Dr.

Role: primary

+49 511 927 2102

Ingolf Schiefke, Prof.

Role: primary

Albrecht Hoffmeister, Prof. Dr.

Role: primary

++49 - 341 - 97 12240

Andreas Wannhoff, Dr.

Role: primary

+4971419967201

Ulrike Denzer, Prof.

Role: primary

Jörg Schirra, Prof. Dr.

Role: primary

+49 89 4400 73031

Jonel Trebicka, Prof.

Role: primary

+492518343330

Alexander Dechêne, Prof.

Role: primary

Arthur Schmidt

Role: primary

Christoph Werner, Dr.

Role: primary

+49 7071 2982712

Other Identifiers

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2022-500107-50-00

Identifier Type: OTHER

Identifier Source: secondary_id

434336116

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

CARP

Identifier Type: -

Identifier Source: org_study_id

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