Photodynamic therapy in unresectable cholangiocarcinoma: not for the uncommitted

Jayant P Talreja, Marisa Degaetani, Kristi Ellen, Timothy Schmitt, Monica Gaidhane, Michel Kahaleh, Jayant P Talreja, Marisa Degaetani, Kristi Ellen, Timothy Schmitt, Monica Gaidhane, Michel Kahaleh

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.

Keywords: Cholangiocarcinoma; Photodynamic therapy; Single operator choledochoscopy.

Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Fluoroscopy demonstrating malignant stricture involving the confluence.
Fig. 2
Fig. 2
Single operator choledochoscope placed below the stricture to be treated.
Fig. 3
Fig. 3
(A) Choledochoscopy after centering the fiber diffuser at the level of the stricture. (B) Choledochoscopy after 3 months postphotodynamic therapy.
Fig. 4
Fig. 4
Kaplan-Meier analysis. (A) Photodynamic therapy+chemotherapy+radiation therapy. (B) Photodynamic therapy only. CI, confidence interval.

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Source: PubMed

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