Long-Term Outcome of Photodynamic Therapy with Systemic Chemotherapy Compared to Photodynamic Therapy Alone in Patients with Advanced Hilar Cholangiocarcinoma
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Background/Aims: Patients with cholangiocarcinoma usuallypresent at an advanced stage, and more than 50% ofcases are not resectable at the time of diagnosis. Recently,photodynamic therapy (PDT) has been proposed as a palliativeand neoadjuvant modality. We evaluated whether combinationof PDT and chemotherapy is more effective than PDT alone. Methods: In total, 161 patients with cholangiocarcinomadiagnosed between February 1999 and September2009 were evaluated. Sixteen patients were treated withPDT and chemotherapy (group A), and 58 were treated withPDT (group B). Results: The median survival was 538 days(95% confidence interval [CI], 475.3 to 600.7) in group Aand 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 thenumber of PDT sessions were prognostic factors with statisticalsignificance in the univariate analysis. A multivariateanalysis showed that PDT with chemotherapyand more thantwo sessions of PDT were significant independent predictorsof longer survival in advanced cholangiocarcinoma (hazardratio [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 withchemotherapy results in longer survival than PDT alone.
Abstract
Background/Aims: Patients with cholangiocarcinoma usuallypresent at an advanced stage, and more than 50% ofcases are not resectable at the time of diagnosis. Recently,photodynamic therapy (PDT) has been proposed as a palliativeand neoadjuvant modality. We evaluated whether combinationof PDT and chemotherapy is more effective than PDT alone. Methods: In total, 161 patients with cholangiocarcinomadiagnosed between February 1999 and September2009 were evaluated. Sixteen patients were treated withPDT and chemotherapy (group A), and 58 were treated withPDT (group B). Results: The median survival was 538 days(95% confidence interval [CI], 475.3 to 600.7) in group Aand 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 thenumber of PDT sessions were prognostic factors with statisticalsignificance in the univariate analysis. A multivariateanalysis showed that PDT with chemotherapyand more thantwo sessions of PDT were significant independent predictorsof longer survival in advanced cholangiocarcinoma (hazardratio [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 withchemotherapy results in longer survival than PDT alone.
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