Photodynamic therapy for unresectable cholangiocarcinoma is associated with improvement in cholestasis, quality of life, and potentially survival.
Dr Michel Kahaleh and colleagues from Virginia, USA compared survival in patients with unresectable cholangiocarcinoma undergoing endoscopic retrograde cholangiopancreatography with photodynamic therapy.
The team assessed stent placement with a group undergoing endoscopic retrograde cholangiopancreatography with stent placement alone.
|Mortality in the photodynamic therapy group at 6 months 16%|
|Clinical Gastroenterology and Hepatology|
A total of 48 patients were palliated for unresectable cholangiocarcinoma during a 5-year period.
The research team treated 19 patients with photodynamic therapy, and stents, and 29 patients treated with biliary stents alone served as a control group.
The team performed multivariate analysis by using Model for End-Stage Liver Disease score, age, and treatment by chemotherapy or radiation to detect predictors of survival.
The researchers used number of endoscopic retrograde cholangiopancreatography procedures and photodynamic therapy sessions to detect predictors of survival.
The researchers demonstrated that Kaplan-Meier analysis improved survival in the photodynamic therapy group compared with the stent only group.
Mortality in the photodynamic therapy group at 3, 6, and 12 months was 0%, 16%, and 56%, respectively.
The corresponding mortality in the stent group was 28%, 52%, and 82%, respectively.
The team found that the difference between the 2 groups was significant at 3 months, and 6 months but not at 12 months.
Only the number of endoscopic retrograde cholangiopancreatography procedures, and number of photodynamic therapy sessions were significant on multivariate analysis.
Adverse events specific to photodynamic therapy included 3 patients with skin phototoxicity requiring topical therapy only.
Dr Kahalehs' team concluded, "Endoscopic retrograde cholangiopancreatography with photodynamic therapy seems to increase survival in patients with unresectable cholangiocarcinoma when compared with endoscopic retrograde cholangiopancreatography alone."
"It remains to be proved whether this effect is attributable to photodynamic therapy or the number of endoscopic retrograde cholangiopancreatography sessions."
"A prospective randomized multicenter study is required to confirm these data."