Published online Feb 21, 2017. doi: 10.3748/wjg.v23.i7.1278
Peer-review started: June 21, 2016
First decision: August 22, 2016
Revised: September 9, 2016
Accepted: October 10, 2016
Article in press: October 10, 2016
Published online: February 21, 2017
To perform a systematic review and meta-analysis on clinical outcomes of photodynamic therapy (PDT) in non-resectable cholangiocarcinoma.
Included studies compared outcomes with photodynamic therapy and biliary stenting (PDT group) vs biliary stenting only (BS group) in palliation of non-resectable cholangiocarcinoma. Articles were searched in MEDLINE, PubMed, and EMBASE. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using the I2 statistic.
Ten studies (n = 402) that met inclusion criteria were included in this analysis. The P for χ2 heterogeneity for all the pooled accuracy estimates was > 0.10. Pooled odds ratio for successful biliary drainage (decrease in bilirubin level > 50% within 7days after stenting) in PDT vs BS group was 4.39 (95%CI: 2.35-8.19). Survival period in PDT and BS groups were 413.04 d (95%CI: 349.54-476.54) and 183.41 (95%CI: 136.81-230.02) respectively. The change in Karnofsky performance scores after intervention in PDT and BS groups were +6.99 (95%CI: 4.15-9.82) and -3.93 (95%CI: -8.63-0.77) respectively. Odds ratio for post-intervention cholangitis in PDT vs BS group was 0.57 (95%CI: 0.35-0.94). In PDT group, 10.51% (95%CI: 6.94-14.72) had photosensitivity reactions that were self-limiting. Subgroup analysis of prospective studies showed similar results, except the incidence of cholangitis was comparable in both groups.
In palliation of unresectable cholangiocarcinoma, PDT seems to be significantly superior to BS alone. PDT should be used as an adjunct to biliary stenting in these patients.
Core tip: Role of photodynamic therapy (PDT) in unresectable cholangiocarcinoma has been scarcely described in the past. However most of these studies included patients who also underwent additional palliative measures simultaneously. Hence, overall safety and efficacy of photodynamic therapy is not clear. This is the first systematic review and meta-analysis evaluating exclusively the role of PDT in these patients. PDT with biliary stenting was compared to biliary stenting (BS) alone. PDT seems to be relatively safe and significantly superior to BS alone in this patient population.