Clin Endosc.  2013 Jul;46(4):390-394.

Photodynamic Therapy in Unresectable Cholangiocarcinoma: Not for the Uncommitted

• Talreja JP
• DeGaetani
• Ellen K
• Schmitt T
• Gaidhane M
• Kahaleh M

Abstract

BACKGROUND/AIMS
Photodynamic therapy (PDT) in unresectable cholangiocarcinoma has been associated with improved survival. We report a single tertiary care center experience over the past 6 years.
METHODS
Fifty-five patients with unresectable cholangiocarcinoma received PDT between 2004 and 2010. Plastic stents were placed after PDT to prevent cholangitis.
RESULTS
Twenty-seven patients (49%) showed Bismuth type IV, 22 (41%) showed Bismuth type III, and six (10%) showed Bismuth type I and II. Twenty patients (37%) received chemotherapy and radiation therapy, five (9%) received chemotherapy only; and one (2%) received radiation therapy only. Mean number of PDT sessions was 1.9+/-1.5 sessions (range, 1 to 9). Mean survival duration was 293+/-266 days (median, 190; range, 25 to 1,332). PDT related complications included three (5%) facial burn, three (5%) photosensitivity, and two (3%) rash. Kaplan-Meier analysis comparing the survival means of patients who received PDT and chemotherapy/radiation therapy (median survival 257 days; 95% confidence interval [CI], 166 to 528) versus who received PDT only (median survival 183 days; 95% CI, 129 to 224) showed no significant difference (log-rank p=0.20).
CONCLUSIONS
PDT has a measurable impact on survival in unresectable cholangiocarcinoma but requires aggressive stenting posttherapy.

Keyword

Photodynamic therapy; Cholangiocarcinoma; Single operator choledochoscopy

MeSH Terms

Bismuth
Burns
Cholangiocarcinoma
Exanthema
Humans
Kaplan-Meier Estimate
Photochemotherapy
Plastics
Stents
Tertiary Care Centers
Triazenes
Bismuth
Plastics
Triazenes

Figure

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  Fig. 1 Fluoroscopy demonstrating malignant stricture involving the confluence.

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  Fig. 2 Single operator choledochoscope placed below the stricture to be treated.

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  Fig. 3 (A) Choledochoscopy after centering the fiber diffuser at the level of the stricture. (B) Choledochoscopy after 3 months postphotodynamic therapy.

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  Fig. 4 Kaplan-Meier analysis. (A) Photodynamic therapy+chemotherapy+radiation therapy. (B) Photodynamic therapy only. CI, confidence interval.

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