ERCP-directed radiofrequency ablation and photodynamic therapy are associated with comparable survival in the treatment of unresectable cholangiocarcinoma.
BACKGROUND
Cholangiocarcinoma (CCA) is a malignancy with a poor 5-year survival rate (5%-10%). ERCP-directed radiofrequency ablation (RFA) or photodynamic therapy (PDT) can be performed as palliative therapy for unresectable CCA. ERCP with PDT is associated with improved survival compared with stent placement alone. However, ERCP-directed RFA has not been directly compared with PDT in patients with CCA.


OBJECTIVE
To compare overall survival in patients with unresectable CCA who underwent palliative ERCP-directed RFA versus PDT.


METHODS
Retrospective cohort study.


METHODS
Tertiary-care academic medical center.


METHODS
Forty-eight patients with unresectable CCA who underwent ERCP-directed ablative therapy for palliation of unresectable CCA.


METHODS
ERCP-directed RFA or PDT.


METHODS
Overall survival by Kaplan-Meier analysis after initial treatment with either RFA or PDT.


RESULTS
Patients who underwent RFA (n = 16) demonstrated an overall survival similar to that of those who underwent PDT (n = 32), with a median survival of 9.6 versus 7.5 months, respectively (P = .799). Patient age (P = .45), sex (P = .52), and lead time (P = .59) from presentation to initial RFA or PDT had no significant association with survival. The presence of distant metastasis was inversely associated with survival (hazard ratio 3.55; 95% confidence interval, 1.29-9.77; P = .014). Patients who underwent RFA (compared with PDT) had a lower mean number of plastic stents placed per month (0.45 vs 1.10, P = .001) but also had more episodes of stent occlusion (0.06 vs 0.02, P = .008) and cholangitis (0.13 vs 0.05, P = .008) per month.


CONCLUSIONS
Retrospective, single-center design.


CONCLUSIONS
Survival after ERCP-directed RFA and PDT was not statistically different in patients with unresectable CCA. A randomized, controlled trial is warranted to validate these preliminary results.
Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, USA.
Daniel S
DS
Strand
Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, USA.
Natalie D
ND
Cosgrove
Division of Biostatistics and Epidemiology, University of Virginia Health System, Charlottesville, Virginia, USA.
James T
JT
Patrie
Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, USA.
Dawn G
DG
Cox
Division of Surgical Oncology, University of Virginia Health System, Charlottesville, Virginia, USA.
Todd W
TW
Bauer
Division of Surgical Oncology, University of Virginia Health System, Charlottesville, Virginia, USA.
Reid B
RB
Adams
Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, USA.
James A
JA
Mann
Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, USA.
Bryan G
BG
Sauer
Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, USA.
Vanessa M
VM
Shami
Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, USA.
Andrew Y
AY
Wang
D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D017115:Catheter Ablation / Q000379:methods; D018281:Cholangiocarcinoma / Q000401:mortality / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015331:Cohort Studies; D017323:Dihematoporphyrin Ether / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D054023:Lasers, Semiconductor / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010778:Photochemotherapy / Q000379:methods; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods; D015996:Survival Rate
D017319:Photosensitizing Agents; D017323:Dihematoporphyrin Ether