Photodynamic therapy for unresectable cholangiocarcinoma: contribution of single operator cholangioscopy for targeted treatment

Abstract

Photodynamic therapy (PDT) for unresectable cholangiocarcinoma is associated with improvement in cholestasis and survival. Single operator cholangioscopy (SOC) has been used for targeted laser illumination. We analyzed our growing experience of SOC with direct PDT. This is a retrospective analysis of a consecutive series of patients prospectively entered into a registry. Forty-five patients (24 male, aged 67.3 ± 10.6 years) were treated with PDT for cholangiocarcinoma during a five-year period. Thirty-two patients were treated with ERCP and PDT alone, and 13 were treated with ERCP and PDT using SOC. The two groups were then compared to observe any statistically significant difference in regards to age, gender, serum bilirubin, MELD score, adverse effects, or survival. An overall median of 1 PDT session per patient (range: 1-9) was performed. Twenty-six total sessions of PDT using SOC were performed in 13 patients with a median of 2.0 sessions per patient (range: 1-6). Median global survival was 168 days (range: 26-1353). Median survival for the PDT-only group was 200 days, and median survival for the PDT-with-SOC group was 386 days (p = 0.45). There was a statistically significant difference (p < 0.0001) between the two groups in regards to fluoroscopy time, with the PDT-only group having a median time of 21.1 min and the PDT-with-SOC group having a median time of 11.1 min. PDT related complications included 7 cases of mild phototoxicity and one case of moderate phototoxicity requiring hospitalization. SOC permits targeted therapy during PDT and can be successfully performed without adverse events while simultaneously reducing exposure to radiation.

Photodynamic Therapy in Unresectable Cholangiocarcinoma: Not for the Uncommitted

“…It also has been shown to influence decisions regarding patient management 5,6. Our group compared PDT versus SOC directed PDT and found the therapies to be comparable without an increase in adverse complications, but with decreased radiation exposure in the SOC-directed group 15. Another recent study demonstrated that direct POC-guided PDT using an ultraslim upper endoscope is both feasible and safe in select patients with inoperable extrahepatic cholangiocarcinoma 16…”

Endoscopic treatment options for cholangiocarcinoma

“…Cholangioscopy-guided PDT allows for the identification of tumor margins and determination of the appropriate location for placement of the diffuser (Figure 4); it also allows for evaluation of the response to therapy (Figure 5). Talreja et al compared patients undergoing PDT with those undergoing cholangioscopy with direct PDT [69]. While the median survival time between the groups was not different, there was a statistically significant difference between the groups in terms of fluoroscopy time, as median time was 21.1 min with PDT and 11.1 min with cholangioscopy with direct PDT, thus allowing for decreased radiation exposure for both patients and healthcare professionals.…”

Biliary Tumor Ablation with Photodynamic Therapy and Radiofrequency Ablation

“…In a study, the median survival of patients treated with PDT only was 200 days compared with 386 days in those treated with cholangioscopy with direct PDT (P 5 .45). 18 Cholangioscopy permitted targeted therapy during PDT while simultaneously reducing exposure to radiation (21.1 vs 11.1 minutes, P<.0001). 18 In a small prospective study, PDT under direct peroral cholangioscopy with an ultraslim upper endoscope was successfully performed in 7 of 9 patients and in 15 of 17 sessions.…”

“…18 Cholangioscopy permitted targeted therapy during PDT while simultaneously reducing exposure to radiation (21.1 vs 11.1 minutes, P<.0001). 18 In a small prospective study, PDT under direct peroral cholangioscopy with an ultraslim upper endoscope was successfully performed in 7 of 9 patients and in 15 of 17 sessions. 19 Biliary drainage under direct peroral cholangioscopy was possible in 7 of 7 patients who needed it after PDT.…”