Success of photodynamic therapy in palliating patients with nonresectable cholangiocarcinoma: A systematic review and meta-analysis

Moole, Harsha; Tathireddy, Harsha; Dharmapuri, Sirish; Moole, Vishnu; Boddireddy, Raghuveer R.; Yedama, Pratyusha; Dharmapuri, Sowmya; Uppu, Achuta; Bondalapati, Naveen; Duvvuri, Abhiram

doi:10.3748/wjg.v23.i7.1278

Cited by 105 publications

(92 citation statements)

References 61 publications

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“…Comparing adverse events in our study with previously published findings, the proportion of patients in the PDT chemotherapy combination group who suffered from cholangitis (55.5%) was lower than in the retrospective study by Wentrup et al (75.8% in the combination group), but higher than in the retrospective study by Hong et al (6.3% in the combination group) . The proportion of patients who suffered from skin toxicity (8.8% in the PDT alone group and 11.1% in the PDT chemotherapy combination group) was comparable with data reported in a recent pooled meta‐analysis, which found self‐limiting photosensitivity reactions in 10.51% of all patients …”

Section: Discussionsupporting

confidence: 89%

Combined photodynamic therapy with systemic chemotherapy for unresectable cholangiocarcinoma

Gonzalez‐Carmona

Bolch

Jansen

et al. 2019

Aliment Pharmacol Ther

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Summary Background Chemotherapy with gemcitabine and cisplatin is the current standard for patients with unresectable cholangiocarcinoma. Local photodynamic therapy has also demonstrated benefit in patients with extrahepatic cholangiocarcinoma. Aim To evaluate the benefit of photodynamic therapy in combination with systemic chemotherapy in advanced extrahepatic cholangiocarcinoma. Methods Three hundred and fifty‐three patients diagnosed with cholangiocarcinoma between 2004 and 2016 were treated at the University Hospital of Bonn, Germany. Of these, 96 suffering from unresectable extrahepatic cholangiocarcinoma were included. Patients were stratified according to treatment: combination photodynamic therapy and chemotherapy (36 patients), photodynamic therapy alone (34 patients), and chemotherapy alone (26 patients). Results Combined photodynamic therapy with chemotherapy resulted in significantly longer overall survival than chemotherapy alone (P = 0.022). Median survival was 20 months in the combination group (95% CI: 16.38‐23.62), 15 months in the photodynamic alone group (95% CI: 10.02‐19.98) and 10 months in the chemotherapy alone group (95% CI: 8.45‐11.55). In multivariate analysis, combination therapy and photodynamic therapy alone (HR: 0.41, 95% CI: 0.22‐0.77, P = 0.006), metal stenting, and radiofrequency ablation were independent predictors of longer survival. Conclusions Combination photodynamic therapy and chemotherapy was well tolerated and resulted in significantly longer survival than chemotherapy alone. Application of photodynamic therapy significantly correlated with longer survival, demonstrating benefit in advanced cholangiocarcinoma. Thus, photodynamic therapy should be considered during therapeutic decision making in advanced cholangiocarcinoma.

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Section: Discussionsupporting

confidence: 89%

Combined photodynamic therapy with systemic chemotherapy for unresectable cholangiocarcinoma

Gonzalez‐Carmona

Bolch

Jansen

et al. 2019

Aliment Pharmacol Ther

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“…In a randomized trial of 26 patients with pancreatic cancer, EUS‐RFA has recently been compared to traditional celiac‐plexus neurolysis showing more pain relief, improved quality of life and comparable adverse events . Photodynamic therapy is another palliative modality for cholangiocarcinoma . In a randomized trial (39 patients), photodynamic therapy improved survival in patients with non‐resectable cholangiocarcinoma (493 days vs 98 days, P < 0.0001) .…”

Section: Interventional Eus: New Tools New (And Old) Applicationsmentioning

confidence: 99%

“…In a randomized trial (39 patients), photodynamic therapy improved survival in patients with non‐resectable cholangiocarcinoma (493 days vs 98 days, P < 0.0001) . In a recent meta‐analysis of 10 studies (402 patients), photodynamic therapy appeared safe and superior to biliary stenting alone according to successful biliary drainage and survival rate …”

Section: Interventional Eus: New Tools New (And Old) Applicationsmentioning

confidence: 99%

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Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

Tontini

Manfredi

Orlando

et al. 2019

Digestive Endoscopy

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Over the last decade, impressive technological advances have occurred in ultrasonography and small‐bowel endoscopy. Nowadays, endoscopic ultrasonography is an essential diagnostic tool and a therapeutic weapon for pancreatobiliary disorders. Capsule endoscopy and device‐assisted enteroscopy have quickly become the reference standard for the diagnosis of small‐bowel luminal diseases, thereby leading to radical changes in diagnostic and therapeutic pathways. We herein provide an up‐to‐date overview of the latest advances in endoscopic ultrasonography and small‐bowel endoscopy, focusing on the emerging paradigms and technological innovations that might improve clinical practice in the near future.

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“…An SRMA (10 studies, n = 402) comparing PDT (percutaneous or endoscopic) versus stenting alone in unresectable cholangiocarcinoma found a significant increase in OS with PDT (413 vs 183 days) with no significant difference in rates of cholangitis, although 10.5% of PDT patients had photosensitivity reactions [25]. This SRMA did not include an RCT comparing EBS versus EBS with PDT that was stopped due to worse OS in the PDT group (5.6 vs 8.5 months) [26].…”

Section: Endoscopic Therapiesmentioning

confidence: 99%

Locoregional therapies in cholangiocarcinoma

et al. 2017

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Cholangiocarcinoma is a rare and aggressive malignancy of the biliary tract. Complete surgical resection can be curative, but the majority of patients are diagnosed with advanced disease and usually die within a year of diagnosis. Most deaths are attributable to local disease progression rather than distant metastases, supporting the use of locoregional therapies. There is evidence that locoregional therapies can provide local tumor control resulting in increased survival while avoiding some of the side effects of systemic treatments, increasing potential treatment options for patients who may be unsuitable for systemic palliative treatments. This review considers the evidence for locoregional therapies in cholangiocarcinoma, which can be classified into endoscopic, vascular, percutaneous and radiation oncological therapies. Current guidelines do not recommend the routine use of locoregional therapies due to a lack of prospective data, but the results of ongoing trials are likely to increase the evidence base and impact on clinical practice.

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Success of photodynamic therapy in palliating patients with nonresectable cholangiocarcinoma: A systematic review and meta-analysis

Cited by 105 publications

References 61 publications

Combined photodynamic therapy with systemic chemotherapy for unresectable cholangiocarcinoma

Combined photodynamic therapy with systemic chemotherapy for unresectable cholangiocarcinoma

Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

Locoregional therapies in cholangiocarcinoma

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