title: Success of photodynamic therapy in palliating patients with nonresectable cholangiocarcinoma: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To perform a systematic review and meta-analysis on clinical outcomes of photodynamic therapy (PDT) in non-resectable cholangiocarcinoma.
  
  
  METHODS
  Included studies compared outcomes with photodynamic therapy and biliary stenting (PDT group)vsbiliary stenting only (BS group) in palliation of non-resectable cholangiocarcinoma. Articles were searched in MEDLINE, PubMed, and EMBASE. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using theI2statistic.
  
  
  RESULTS
  Ten studies (n= 402) that met inclusion criteria were included in this analysis. ThePfor χ2heterogeneity for all the pooled accuracy estimates was > 0.10. Pooled odds ratio for successful biliary drainage (decrease in bilirubin level > 50% within 7days after stenting) in PDTvsBS group was 4.39 (95%CI: 2.35-8.19). Survival period in PDT and BS groups were 413.04 d (95%CI: 349.54-476.54) and 183.41 (95%CI: 136.81-230.02) respectively. The change in Karnofsky performance scores after intervention in PDT and BS groups were +6.99 (95%CI: 4.15-9.82) and -3.93 (95%CI: -8.63-0.77) respectively. Odds ratio for post-intervention cholangitis in PDTvsBS group was 0.57 (95%CI: 0.35-0.94). In PDT group, 10.51% (95%CI: 6.94-14.72) had photosensitivity reactions that were self-limiting. Subgroup analysis of prospective studies showed similar results, except the incidence of cholangitis was comparable in both groups.
  
  
  CONCLUSIONS
  In palliation of unresectable cholangiocarcinoma, PDT seems to be significantly superior to BS alone. PDT should be used as an adjunct to biliary stenting in these patients.
authors.affiliation: Harsha Moole, Harsha Tathireddy, Department of Medicine, University of Illinois College of Medicine, Peoria, IL 61637, United States.
authors.forename: Harsha
authors.initials: H
authors.lastname: Moole
authors.affiliation: Harsha Moole, Harsha Tathireddy, Department of Medicine, University of Illinois College of Medicine, Peoria, IL 61637, United States.
authors.forename: Harsha
authors.initials: H
authors.lastname: Tathireddy
authors.affiliation: Harsha Moole, Harsha Tathireddy, Department of Medicine, University of Illinois College of Medicine, Peoria, IL 61637, United States.
authors.forename: Sirish
authors.initials: S
authors.lastname: Dharmapuri
authors.affiliation: Harsha Moole, Harsha Tathireddy, Department of Medicine, University of Illinois College of Medicine, Peoria, IL 61637, United States.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Moole
authors.affiliation: Harsha Moole, Harsha Tathireddy, Department of Medicine, University of Illinois College of Medicine, Peoria, IL 61637, United States.
authors.forename: Raghuveer
authors.initials: R
authors.lastname: Boddireddy
authors.affiliation: Harsha Moole, Harsha Tathireddy, Department of Medicine, University of Illinois College of Medicine, Peoria, IL 61637, United States.
authors.forename: Pratyusha
authors.initials: P
authors.lastname: Yedama
authors.affiliation: Harsha Moole, Harsha Tathireddy, Department of Medicine, University of Illinois College of Medicine, Peoria, IL 61637, United States.
authors.forename: Sowmya
authors.initials: S
authors.lastname: Dharmapuri
authors.affiliation: Harsha Moole, Harsha Tathireddy, Department of Medicine, University of Illinois College of Medicine, Peoria, IL 61637, United States.
authors.forename: Achuta
authors.initials: A
authors.lastname: Uppu
authors.affiliation: Harsha Moole, Harsha Tathireddy, Department of Medicine, University of Illinois College of Medicine, Peoria, IL 61637, United States.
authors.forename: Naveen
authors.initials: N
authors.lastname: Bondalapati
authors.affiliation: Harsha Moole, Harsha Tathireddy, Department of Medicine, University of Illinois College of Medicine, Peoria, IL 61637, United States.
authors.forename: Abhiram
authors.initials: A
authors.lastname: Duvvuri
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000188:drug therapy*; D001652:Bile Ducts / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D001662:Biliary Tract Surgical Procedures; D018281:Cholangiocarcinoma / Q000188:drug therapy*; D002761:Cholangitis / Q000188:drug therapy*; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D016017:Odds Ratio; D010166:Palliative Care; D010778:Photochemotherapy; D011446:Prospective Studies; D011788:Quality of Life; D012107:Research Design; D015607:Stents; D016896:Treatment Outcome
keywords: Biliary stenting; Meta-analysis; Outcome; Photodynamic therapy; Systematic review; Unresectable cholangiocarcinoma