title: Photodynamic Therapy in Patients with Advanced Hilar Cholangiocarcinoma: Percutaneous Cholangioscopic Versus Peroral Transpapillary Approach.
abstract: OBJECTIVE
  This study aimed to compare the clinical outcomes of patients with advanced hilar cholangiocarcinoma (CC) who underwent photodynamic therapy (PDT) with either percutaneous transhepatic cholangioscopy (PTCS) or endoscopic retrograde cholangiopancreatography (ERCP).
  
  
  BACKGROUND
  PDT has been proposed as a promising therapy for treatment of unresectable hilar CC that is resistant to conventional standard treatment. However, few studies have compared the delivery methods of PDT in unresectable hilar CC patients.
  
  
  METHODS
  Thirty-seven adult patients with advanced hilar CC were included in this study. Twenty-four patients treated with PTCS-directed PDT and 13 patients treated with ERCP-directed PDT were analyzed retrospectively.
  
  
  RESULTS
  The PTCS- and ERCP-directed PDT groups were comparable with respect to age, gender, health status, pretreatment bilirubin levels, Bismuth type, and hilar CC stage. The length of hospital stay differed significantly (p < 0.001) between the two groups, with a median hospital stay of 37 days (range, 13-77 days) in the ERCP-directed PDT group versus 63 days (range, 23-125 days) in the PTCS-directed group. PTCS-directed PDT patients demonstrated an overall survival similar to that of ERCP-directed PDT patients, with a median survival of 11.6 versus 9.5 months, respectively (p = 0.96). Only lower pre-PDT bilirubin levels (p = 0.002) were a significant predictor of improved survival in all patients who underwent PDT, as determined by multivariate analysis. Median metal stent patency was similar between the groups [PTCS-directed PDT group (n = 8), 6.2 months; ERCP-directed PDT group (n = 7), 7.2 months; p = 0.642]. Survival after PTCS- or ERCP-directed PDT was not statistically different in patients with advanced hilar CC.
  
  
  CONCLUSIONS
  Lower pre-PDT bilirubin levels were associated with longer survival in all patients.
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine , Seoul, Korea.
authors.forename: Tae Yoon
authors.initials: TY
authors.lastname: Lee
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine , Seoul, Korea.
authors.forename: Young Koog
authors.initials: YK
authors.lastname: Cheon
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine , Seoul, Korea.
authors.forename: Chan Sup
authors.initials: CS
authors.lastname: Shim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000188:drug therapy* / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D018285:Klatskin Tumor / Q000188:drug therapy* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis