Long-term outcome of photodynamic therapy with systemic chemotherapy compared to photodynamic therapy alone in patients with advanced hilar cholangiocarcinoma.
OBJECTIVE
Patients with cholangiocarcinoma usually present at an advanced stage, and more than 50% of cases are not resectable at the time of diagnosis. Recently, photodynamic therapy (PDT) has been proposed as a palliative and neoadjuvant modality. We evaluated whether combination of PDT and chemotherapy is more effective than PDT alone.


METHODS
In total, 161 patients with cholangiocarcinoma diagnosed between February 1999 and September 2009 were evaluated. Sixteen patients were treated with PDT and chemotherapy (group A), and 58 were treated with PDT (group B).


RESULTS
The median survival was 538 days (95% confidence interval [CI], 475.3 to 600.7) in group A and 334 days (95% CI, 252.5 to 415.5) in group B (p=0.05). Lymph node metastasis status, serum bilirubin of pretreatment, tumor node metastasis stage, treatment method (PDT with chemotherapy vs PDT alone), time to PDT and the number of PDT sessions were prognostic factors with statistical significance in the univariate analysis. A multivariate analysis showed that PDT with chemotherapy and more than two sessions of PDT were significant independent predictors of longer survival in advanced cholangiocarcinoma (hazard ratio [HR], 2.23; 95% CI, 1.18 to 4.20; p=0.013 vs HR, 1.79; 95% CI, 1.044 to 3.083; p=0.034).


CONCLUSIONS
PDT with chemotherapy results in longer survival than PDT alone.
Department of Internal Medicine, Digestive Disease Centre, Konkuk University School of Medicine, Seoul, Korea.
Mi Jin
MJ
Hong
Department of Internal Medicine, Digestive Disease Centre, Konkuk University School of Medicine, Seoul, Korea.
Young Koog
YK
Cheon
Department of Internal Medicine, Digestive Disease Centre, Konkuk University School of Medicine, Seoul, Korea.
Eung Jun
EJ
Lee
Department of Internal Medicine, Digestive Disease Centre, Konkuk University School of Medicine, Seoul, Korea.
Tae Yoon
TY
Lee
Department of Internal Medicine, Digestive Disease Centre, Konkuk University School of Medicine, Seoul, Korea.
Chan Sup
CS
Shim
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001650:Bile Duct Neoplasms / Q000188:drug therapy*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000188:drug therapy* / Q000401:mortality; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000401:mortality; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D000093542:Gemcitabine
D003841:Deoxycytidine; D002945:Cisplatin; D005472:Fluorouracil; D000093542:Gemcitabine
Cholangiocarcinoma; Drug therapy; Photochemotherapy