Unresectable cholangiocarcinoma: comparison of survival in biliary stenting alone versus stenting with photodynamic therapy.
OBJECTIVE
Photodynamic therapy (PDT) for unresectable cholangiocarcinoma is associated with improvement in cholestasis, quality of life, and potentially survival. We compared survival in patients with unresectable cholangiocarcinoma undergoing endoscopic retrograde cholangiopancreatography (ERCP) with PDT and stent placement with a group undergoing ERCP with stent placement alone.


METHODS
Forty-eight patients were palliated for unresectable cholangiocarcinoma during a 5-year period. Nineteen were treated with PDT and stents; 29 patients treated with biliary stents alone served as a control group. Multivariate analysis was performed by using Model for End-Stage Liver Disease score, age, treatment by chemotherapy or radiation, and number of ERCP procedures and PDT sessions to detect predictors of survival.


RESULTS
Kaplan-Meier analysis demonstrated improved survival in the PDT group compared with the stent only group (16.2 vs 7.4 months, P<.004). Mortality in the PDT 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 difference between the 2 groups was significant at 3 months and 6 months but not at 12 months. Only the number of ERCP procedures and number of PDT sessions were significant on multivariate analysis. Adverse events specific to PDT included 3 patients with skin phototoxicity requiring topical therapy only.


CONCLUSIONS
ERCP with PDT seems to increase survival in patients with unresectable cholangiocarcinoma when compared with ERCP alone. It remains to be proved whether this effect is attributable to PDT or the number of ERCP sessions. A prospective randomized multicenter study is required to confirm these data.
Kahaleh
Michel
M
Digestive Health Center, University of Virginia Health System, Charlottesville, Virginia 22908-0708, USA. mk5ke@virginia.edu
Mishra
Rajnish
R
Shami
Vanessa M
VM
Northup
Patrick G
PG
Berg
Carl L
CL
Bashlor
Penny
P
Jones
Petra
P
Ellen
Kristi
K
Weiss
Geoffrey R
GR
Brenin
Christiana M
CM
Kurth
Barbara E
BE
Rich
Tyvin A
TA
Adams
Reid B
RB
Yeaton
Paul
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D001653:Bile Ducts, Intrahepatic; D044963:Biopsy, Fine-Needle; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017323:Dihematoporphyrin Ether / Q000008:administration & dosage* / Q000627:therapeutic use; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D017319:Photosensitizing Agents / Q000008:administration & dosage / Q000627:therapeutic use; D010789:Phototherapy / Q000379:methods*; D019919:Prosthesis Implantation / Q000295:instrumentation*; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D017319:Photosensitizing Agents; D017323:Dihematoporphyrin Ether