Clin Endosc.  2013 Jul;46(4):390-394.

Photodynamic Therapy in Unresectable Cholangiocarcinoma: Not for the Uncommitted

Affiliations
  • 1Department of Gastroenterology and Hepatology, University of Virginia School of Medicine, Charlottesville, VA, USA.
  • 2Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA. mkahaleh@gmail.com

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
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