Gut Liver.  2016 May;10(3):470-475. 10.5009/gnl15175.

Photodynamic Therapy Plus Chemotherapy Compared with Photodynamic Therapy Alone in Hilar Nonresectable Cholangiocarcinoma

• Wentrup R
• Winkelmann N
• Mitroshkin A
• Prager M
• Voderholzer W
• Schachschal G
• Jürgensen C
• Büning C

• KMID: 2411976
• DOI: http://doi.org/10.5009/gnl15175

Abstract

BACKGROUND/AIMS
Standard treatments are not available for hilar nonresectable cholangiocarcinoma (NCC). It is unknown whether combination therapy of photodynamic therapy (PDT) plus systemic chemotherapy is superior to PDT alone.
METHODS
We retrospectively reviewed 68 patients with hilar NCC treated with either PDT plus chemotherapy (PTD-C) or PDT monotherapy (PDT-M). The primary endpoint was the mean overall survival rate. Secondary endpoints included the 1-year survival rate, risk of cholangitic complications, and outcomes, which were evaluated according to the chemotherapy protocol.
RESULTS
More than 90% of the study population had advanced hilar NCC Bismuth type III or IV. In the PDT-M group (n=35), the mean survival time was 374 days compared with 520 days in the PDT-C group (n=33, p=0.021). The 1-year survival rate was significantly higher in the PDT-C group compared with the PDT-M group (88% vs 58%, p=0.001) with a significant reduction of mortality (hazard ratio, 0.20; 95% confidence interval, 0.07 to 0.58; p=0.003). Gemcitabine monotherapy resulted in a shorter survival time compared with the gemcitabine combination therapy (mean, 395 days vs 566 days; p=0.09). Cholangitic complications were observed at a similar frequency in the PDT-C and PDT-M groups.
CONCLUSIONS
Combining repeated PDT with a gemcitabine-based combination therapy might offer a significant survival benefit in patients with hilar NCC.

Keyword

Nonresectable cholangiocarcinoma; Photochemotherapy; Chemotherapy; Survival

MeSH Terms

Aged
Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
Bile Duct Neoplasms/*drug therapy/mortality
Cholangiocarcinoma/*drug therapy/mortality
Cisplatin/administration & dosage
Combined Modality Therapy
Deoxycytidine/administration & dosage/analogs & derivatives
Endoscopy, Digestive System
Female
Fluorouracil/administration & dosage
Humans
Male
Middle Aged
Organoplatinum Compounds/administration & dosage
Photochemotherapy/*methods/mortality
Randomized Controlled Trials as Topic
Stents
Treatment Outcome
Organoplatinum Compounds
Deoxycytidine
Cisplatin
Fluorouracil