Factors associated with increased survival after photodynamic therapy for cholangiocarcinoma.
OBJECTIVE
Recent studies have shown a survival advantage using photodynamic therapy (PDT) in patients with unresectable cholangiocarcinoma. Factors associated with increased survival after PDT are unknown.


METHODS
Twenty-five patients with cholangiocarcinoma who were treated with PDT at the Mayo Clinic Rochester from 1991 to 2004 were studied. Porfimer sodium (2 mg/kg) was administered intravenously to patients with Bismuth type I (3 patients), type III a/b (13 patients), and type IV (9 patients) tumors. Forty-eight hours later, PDT was administered using a 1.5- to 2.5-cm diffusing fiber that was advanced across the tumor by either retrograde (20 patients) or percutaneous (5 patients) cholangiography. Laser light was applied for a total energy of 180 J/cm2 in 1-3 applications. Patients received PDT treatments every 3 months. Plastic biliary stents (10-11.5 F) were inserted to decompress the biliary system after PDT. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards models.


RESULTS
Patients were 64 (standard error of the mean, +/-2.6) years of age; 20 (80%) were men. The median overall survival period was 344 days. The median survival period after PDT was 214 days. The 1-year survival rate was 30%. On multivariate analysis, the presence of a visible mass on imaging studies (hazard ratio, 3.55; 95% confidence interval, 1.21-10.38), and increasing time between diagnosis and PDT (hazard ratio, 1.13; 95% confidence interval, 1.02-1.25) predicted a poorer survival rate after PDT. A higher serum albumin level (hazard ratio, 0.16; 95% confidence interval, 0.04-0.59) predicted a lower mortality rate after PDT.


CONCLUSIONS
Patients with unresectable cholangiocarcinoma without a visible mass may benefit from earlier treatment with PDT.
Prasad
Ganapathy A
GA
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Wang
Kenneth K
KK
Baron
Todd H
TH
Buttar
Navtej S
NS
Wongkeesong
Louis-Michel
LM
Roberts
Lewis R
LR
LeRoy
Andrew J
AJ
Lutzke
Lori S
LS
Borkenhagen
Lynn S
LS
D000368:Aged; D000970:Antineoplastic Agents; D001650:Bile Duct Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000188:drug therapy* / Q000401:mortality*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D005260:Female; D006414:Hematoporphyrin Photoradiation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D016019:Survival Analysis
D000970:Antineoplastic Agents; D017319:Photosensitizing Agents; D012709:Serum Albumin