title: Photodynamic therapy provides local control of cholangiocarcinoma in patients awaiting liver transplantation.
abstract: Many transplant centers use endoscopically directed brachytherapy to provide locoregional control in patients with otherwise incurable cholangiocarcinoma (CCA) who are awaiting liver transplantation (LT). The use of endoscopic retrograde cholangiopancreatography (ERCP)-directed photodynamic therapy (PDT) as an alternative to brachytherapy for providing locoregional control in this patient population has not been studied. The aim of this study was to report on our initial experience using ERCP-directed PDT to provide local control in patients with unresectable CCA who were awaiting LT. Patients with unresectable CCA who underwent protocol-driven neoadjuvant chemoradiation and ERCP-directed PDT with the intent of undergoing LT were reviewed. Four patients with confirmed or suspected CCA met the inclusion criteria for protocol LT. All four patients (100%) successfully underwent ERCP-directed PDT. All patients had chemoradiation dose delays, and two patients had recurrent cholangitis despite PDT. None of these patients had progressive locoregional disease or distant metastasis following PDT. All four patients (100%) underwent LT. Intention-to-treat disease-free survival was 75% at mean follow-up of 28.1 months. In summary, ERCP-directed PDT is a reasonably well tolerated and safe procedure that may have benefit by maintaining locoregional tumor control in patients with CCA who are awaiting LT.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA.
authors.forename: N D
authors.initials: ND
authors.lastname: Cosgrove
authors.forename: A M
authors.initials: AM
authors.lastname: Al-Osaimi
authors.forename: H K
authors.initials: HK
authors.lastname: Sanoff
authors.forename: M M
authors.initials: MM
authors.lastname: Morris
authors.forename: P W
authors.initials: PW
authors.lastname: Read
authors.forename: D G
authors.initials: DG
authors.lastname: Cox
authors.forename: J A
authors.initials: JA
authors.lastname: Mann
authors.forename: C K
authors.initials: CK
authors.lastname: Argo
authors.forename: C L
authors.initials: CL
authors.lastname: Berg
authors.forename: S J
authors.initials: SJ
authors.lastname: Pelletier
authors.forename: D G
authors.initials: DG
authors.lastname: Maluf
authors.forename: A Y
authors.initials: AY
authors.lastname: Wang
mesh_terms: D000328:Adult; D001650:Bile Duct Neoplasms / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D059248:Chemoradiotherapy; D018281:Cholangiocarcinoma / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018579:Patient Selection; D010778:Photochemotherapy; D011379:Prognosis; D012189:Retrospective Studies; D014850:Waiting Lists
keywords: Cholangiocarcinoma; ERCP; PDT; liver transplantation; photodynamic therapy