Factors Associated With Increased Survival After Photodynamic Therapy for Cholangiocarcinoma

Prasad G Iyer, Kenneth Ke Ning Wang, Todd H. Baron, Navtej Singh Buttar, Louis Michel Wongkeesong, Lewis Rowland Roberts, Andrew J. LeRoy, Lori S. Lutzke, Lynn S. Borkenhagen

Research output: Contribution to journalArticle

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Abstract

Background & Aims: Recent studies have shown a survival advantage using photodynamic therapy (PDT) in patients with unresectable cholangiocarcinoma. Factors associated with increased survival after PDT are unknown. Methods: Twenty-five patients with cholangiocarcinoma who were treated with PDT at the Mayo Clinic Rochester from 1991 to 2004 were studied. Porfimer sodium (2 mg/kg) was administered intravenously to patients with Bismuth type I (3 patients), type III a/b (13 patients), and type IV (9 patients) tumors. Forty-eight hours later, PDT was administered using a 1.5- to 2.5-cm diffusing fiber that was advanced across the tumor by either retrograde (20 patients) or percutaneous (5 patients) cholangiography. Laser light was applied for a total energy of 180 J/cm2 in 1-3 applications. Patients received PDT treatments every 3 months. Plastic biliary stents (10-11.5 F) were inserted to decompress the biliary system after PDT. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards models. Results: Patients were 64 (standard error of the mean, ±2.6) years of age; 20 (80%) were men. The median overall survival period was 344 days. The median survival period after PDT was 214 days. The 1-year survival rate was 30%. On multivariate analysis, the presence of a visible mass on imaging studies (hazard ratio, 3.55; 95% confidence interval, 1.21-10.38), and increasing time between diagnosis and PDT (hazard ratio, 1.13; 95% confidence interval, 1.02-1.25) predicted a poorer survival rate after PDT. A higher serum albumin level (hazard ratio, 0.16; 95% confidence interval, 0.04-0.59) predicted a lower mortality rate after PDT. Conclusions: Patients with unresectable cholangiocarcinoma without a visible mass may benefit from earlier treatment with PDT.

Original languageEnglish (US)
Pages (from-to)743-748
Number of pages6
JournalClinical Gastroenterology and Hepatology
Volume5
Issue number6
DOIs
StatePublished - Jun 2007

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Cholangiocarcinoma
Photochemotherapy
Survival
Confidence Intervals
Survival Rate
Dihematoporphyrin Ether
Bismuth
Cholangiography
Biliary Tract
Survival Analysis
Proportional Hazards Models
Serum Albumin
Plastics
Stents
Neoplasms
Lasers
Multivariate Analysis
Light

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Factors Associated With Increased Survival After Photodynamic Therapy for Cholangiocarcinoma. / Iyer, Prasad G; Wang, Kenneth Ke Ning; Baron, Todd H.; Buttar, Navtej Singh; Wongkeesong, Louis Michel; Roberts, Lewis Rowland; LeRoy, Andrew J.; Lutzke, Lori S.; Borkenhagen, Lynn S.

In: Clinical Gastroenterology and Hepatology, Vol. 5, No. 6, 06.2007, p. 743-748.

Research output: Contribution to journalArticle

Iyer, Prasad G ; Wang, Kenneth Ke Ning ; Baron, Todd H. ; Buttar, Navtej Singh ; Wongkeesong, Louis Michel ; Roberts, Lewis Rowland ; LeRoy, Andrew J. ; Lutzke, Lori S. ; Borkenhagen, Lynn S. / Factors Associated With Increased Survival After Photodynamic Therapy for Cholangiocarcinoma. In: Clinical Gastroenterology and Hepatology. 2007 ; Vol. 5, No. 6. pp. 743-748.
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abstract = "Background & Aims: Recent studies have shown a survival advantage using photodynamic therapy (PDT) in patients with unresectable cholangiocarcinoma. Factors associated with increased survival after PDT are unknown. Methods: Twenty-five patients with cholangiocarcinoma who were treated with PDT at the Mayo Clinic Rochester from 1991 to 2004 were studied. Porfimer sodium (2 mg/kg) was administered intravenously to patients with Bismuth type I (3 patients), type III a/b (13 patients), and type IV (9 patients) tumors. Forty-eight hours later, PDT was administered using a 1.5- to 2.5-cm diffusing fiber that was advanced across the tumor by either retrograde (20 patients) or percutaneous (5 patients) cholangiography. Laser light was applied for a total energy of 180 J/cm2 in 1-3 applications. Patients received PDT treatments every 3 months. Plastic biliary stents (10-11.5 F) were inserted to decompress the biliary system after PDT. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards models. Results: Patients were 64 (standard error of the mean, ±2.6) years of age; 20 (80{\%}) were men. The median overall survival period was 344 days. The median survival period after PDT was 214 days. The 1-year survival rate was 30{\%}. On multivariate analysis, the presence of a visible mass on imaging studies (hazard ratio, 3.55; 95{\%} confidence interval, 1.21-10.38), and increasing time between diagnosis and PDT (hazard ratio, 1.13; 95{\%} confidence interval, 1.02-1.25) predicted a poorer survival rate after PDT. A higher serum albumin level (hazard ratio, 0.16; 95{\%} confidence interval, 0.04-0.59) predicted a lower mortality rate after PDT. Conclusions: Patients with unresectable cholangiocarcinoma without a visible mass may benefit from earlier treatment with PDT.",
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AU - Iyer, Prasad G

AU - Wang, Kenneth Ke Ning

AU - Baron, Todd H.

AU - Buttar, Navtej Singh

AU - Wongkeesong, Louis Michel

AU - Roberts, Lewis Rowland

AU - LeRoy, Andrew J.

AU - Lutzke, Lori S.

AU - Borkenhagen, Lynn S.

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N2 - Background & Aims: Recent studies have shown a survival advantage using photodynamic therapy (PDT) in patients with unresectable cholangiocarcinoma. Factors associated with increased survival after PDT are unknown. Methods: Twenty-five patients with cholangiocarcinoma who were treated with PDT at the Mayo Clinic Rochester from 1991 to 2004 were studied. Porfimer sodium (2 mg/kg) was administered intravenously to patients with Bismuth type I (3 patients), type III a/b (13 patients), and type IV (9 patients) tumors. Forty-eight hours later, PDT was administered using a 1.5- to 2.5-cm diffusing fiber that was advanced across the tumor by either retrograde (20 patients) or percutaneous (5 patients) cholangiography. Laser light was applied for a total energy of 180 J/cm2 in 1-3 applications. Patients received PDT treatments every 3 months. Plastic biliary stents (10-11.5 F) were inserted to decompress the biliary system after PDT. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards models. Results: Patients were 64 (standard error of the mean, ±2.6) years of age; 20 (80%) were men. The median overall survival period was 344 days. The median survival period after PDT was 214 days. The 1-year survival rate was 30%. On multivariate analysis, the presence of a visible mass on imaging studies (hazard ratio, 3.55; 95% confidence interval, 1.21-10.38), and increasing time between diagnosis and PDT (hazard ratio, 1.13; 95% confidence interval, 1.02-1.25) predicted a poorer survival rate after PDT. A higher serum albumin level (hazard ratio, 0.16; 95% confidence interval, 0.04-0.59) predicted a lower mortality rate after PDT. Conclusions: Patients with unresectable cholangiocarcinoma without a visible mass may benefit from earlier treatment with PDT.

AB - Background & Aims: Recent studies have shown a survival advantage using photodynamic therapy (PDT) in patients with unresectable cholangiocarcinoma. Factors associated with increased survival after PDT are unknown. Methods: Twenty-five patients with cholangiocarcinoma who were treated with PDT at the Mayo Clinic Rochester from 1991 to 2004 were studied. Porfimer sodium (2 mg/kg) was administered intravenously to patients with Bismuth type I (3 patients), type III a/b (13 patients), and type IV (9 patients) tumors. Forty-eight hours later, PDT was administered using a 1.5- to 2.5-cm diffusing fiber that was advanced across the tumor by either retrograde (20 patients) or percutaneous (5 patients) cholangiography. Laser light was applied for a total energy of 180 J/cm2 in 1-3 applications. Patients received PDT treatments every 3 months. Plastic biliary stents (10-11.5 F) were inserted to decompress the biliary system after PDT. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards models. Results: Patients were 64 (standard error of the mean, ±2.6) years of age; 20 (80%) were men. The median overall survival period was 344 days. The median survival period after PDT was 214 days. The 1-year survival rate was 30%. On multivariate analysis, the presence of a visible mass on imaging studies (hazard ratio, 3.55; 95% confidence interval, 1.21-10.38), and increasing time between diagnosis and PDT (hazard ratio, 1.13; 95% confidence interval, 1.02-1.25) predicted a poorer survival rate after PDT. A higher serum albumin level (hazard ratio, 0.16; 95% confidence interval, 0.04-0.59) predicted a lower mortality rate after PDT. Conclusions: Patients with unresectable cholangiocarcinoma without a visible mass may benefit from earlier treatment with PDT.

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