Z Gastroenterol 2016; 54(12): 1343-1404
DOI: 10.1055/s-0036-1597462
4. Tumors/Liver Surgery
Georg Thieme Verlag KG Stuttgart · New York

Combined Photodynamic Therapy with Systemic Chemotherapy Compared to Chemotherapy or Photodynamic Therapy Alone in Patients with Non-Resectable Extrahepatic Cholangiocarcinoma: a Retrospective Study

MA Gonzalez-Carmona
1   University Hospital of Bonn, Department of Internal Medicine I, Bonn, Germany
,
M Bolch
1   University Hospital of Bonn, Department of Internal Medicine I, Bonn, Germany
,
A Vogt
1   University Hospital of Bonn, Department of Internal Medicine I, Bonn, Germany
,
C Jansen
1   University Hospital of Bonn, Department of Internal Medicine I, Bonn, Germany
,
J Nattermann
1   University Hospital of Bonn, Department of Internal Medicine I, Bonn, Germany
,
J Trebicka
1   University Hospital of Bonn, Department of Internal Medicine I, Bonn, Germany
,
CP Strassburg
1   University Hospital of Bonn, Department of Internal Medicine I, Bonn, Germany
,
T Weismüller
1   University Hospital of Bonn, Department of Internal Medicine I, Bonn, Germany
› Author Affiliations
Further Information
Gonzalez-Carmona, Maria A

Publication History

Publication Date:
19 December 2016 (online)

Also available at
 
 

    Background: Photodynamic therapy (PDT) has been shown to be beneficial in patients with non-resectable extrahepatic cholangiocarcinoma. Systemic chemotherapy (SC) with gemcitabine and more recently with gemcitabine and cisplatin is the current first-line chemotherapy for advanced cholangiocarcinoma. This retrospective study analyzed for the first time a large cohort of patients with non-resectable extrahepatic cholangiocarcinoma treated either with combined PDT-SC, SC or PDT alone.

    Methods and patients: 94 patients suffering from non-resectable extrahepatic cholangiocarcinoma were retrospectively analyzed. Patients were stratified according to treatment: systemic chemotherapy alone (SC, n = 29), PDT (n = 33) and a combination of both therapies (PDT-SC, n = 32). Chemotherapy regimens used were usually gemcitabine alone (1000 mg/m2 of body surface area) or in combination with cisplatin (25 mg/m2 of body surface area).

    Results: Median survival of patients treated with PDT-SC was significantly longer (19.5 months) followed by the PDT group (13 months) compared to the SC group (9 months), (p = 0.003 and p = 0.032 respectively) with a hazard ratio [HR] 0.488 (95% confidence interval [CI], 0.266 – 0.894). Grade 3 – 4 toxic adverse events were similar among the different groups. Tumor stage, presence of hepatopathy, history of a second malignacy and treatment method seemed to be prognostic factors with statistical significance in the univariate analysis. In the multivariate analysis, PDT-SC and PDT were significant independent predictors of longer survival.

    Conclusion: Combined PDT with a systemic chemotherapy was feasible, well-tolerated and resulted in significant longer overall survival than chemotherapy alone in patients with extrahepatic cholangiocarcinoma. Interestingly, also PDT alone improved survival compared to chemotherapy alone. Thus, prospective trials are warranted to further define the role of PDT in the standard palliative therapy of cholangiocarcinoma.


    #

    No conflict of interest has been declared by the author(s).

    Gonzalez-Carmona, Maria A