Systematic review: photodynamic therapy for unresectable cholangiocarcinoma

Abstract

Based on currently available evidence, PDT was safe and effective for patients with inoperable cholangiocarcinoma.

386 Photodynamic Therapy in Unresectable Cholangiocarcinoma - Not for the Uncommitted

“…Biliary decompression, which is usually accomplished via endoscopic stent placement, can result in symptom improvement and prevent complications such as cholangitis and sepsis; however, stent placement has not been shown to have any survival benefit 2 and is limited by recurrent stent occlusion. Additionally, (5) 3 (5) 2 (3) PDT, photodynamic therapy.…”

“…Its benefits include symptomatic improvement and prolonged survival with relatively few complications. 2 With PDT, a photosensitizing agent is preferentially retained by the malignant tissue. Following laser activation at a distinct wavelength, toxic oxygen radicals induce apoptosis of malignant cells and cause tumor necrosis.…”

“…2-4 PDT has been reported to have a minimal side effect profile, with the most frequently encountered adverse effect being phototoxicity to the skin. 2 In the last few years we have seen the rise of cholangioscopyguided PDT, which allows better identification of tumor margins, permits targeted laser illumination, and aids in evaluating the response to therapy. 5,6 We now report our experience with PDT, in the treatment of cholangiocarcinoma over the past 6 years.…”

“…However, despite its benefit, PDT was also associated with a substantial incidence of cholangitis requiring stent revision, occurring in just over 50% of our patients. A review of 20 studies of PDT in cholangiocarcinoma found the overall incidence of cholangitis to be 27.5%, 2 with the largest clinical trial showing an incidence of 56%. 17 Another recent study showed a 57% incidence of cholangitis with PDT.…”

“…2,3,[8][9][10][11][12][13] Additionally, it was recently shown that survival in patients who underwent PDT was similar to those in whom curative surgery was attempted but who had positive resection margins, despite the fact that the PDT group had more advanced clinical T stages. 14 Utilization of cholangioscopy with PDT allows direct visualization of the biliary tree, leading to improvements in diagnosis and treatment.…”