Photodynamic therapy for unresectable cholangiocarcinoma: A comparative effectiveness systematic review and meta-analyses

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Abstract

Background: Photodynamic therapy (PDT) with placement of a biliary stent may improve bile duct patency in patients with cholangiocarcinoma (CCA). We aimed to determine the effectiveness of biliary stenting with PDT compared to biliary stenting alone in the palliative treatment of CCA. Materials and methods: Several databases were searched from inception to December 2011 for prospective studies comparing biliary stenting with PDT vs. biliary stenting only for CCA. Outcomes of interest included patient survival, quality of life (using Karnofsky score), and serum bilirubin levels. The relative risk (RR) for dichotomous outcomes and the weighted mean difference (WMD) for continuous outcomes were estimated using DerSimonian and Laird random-effects model. Inconsistency was quantified using I2 statistics. The extent of publication bias was ascertained by visual inspection of funnel plots and Egger's test. Results: There were six studies that met inclusion criteria. A total of 170 participants received PDT and 157 had biliary stenting only. Compared with biliary stenting, PDT was associated with a statistically significant increase in the length of survival (WMD 265 days; 95%CI: 154-376; p=0.01; I2=65%), improvement in Karnofsky scores (WMD 7.74; 95%CI: 3.73-11.76; p=0.01; I2=14%), and a trend for decline in serum bilirubin (WMD -2.92mg/dL; 95%CI: -7.54 to 1.71; p=0.22; I2=94%). The pooled event rate for biliary sepsis was 15% and was similar between PDT and control groups. Conclusion: Palliative treatment of CCA with PDT is associated with increased survival benefit, improved biliary drainage, and quality of life. However, the quality of this evidence is low.

Original languageEnglish (US)
Pages (from-to)189-195
Number of pages7
JournalPhotodiagnosis and Photodynamic Therapy
Volume9
Issue number3
DOIs
StatePublished - Sep 2012

Fingerprint

Cholangiocarcinoma
Photochemotherapy
Meta-Analysis
Palliative Care
Bilirubin
Survival
Quality of Life
Publication Bias
Bile Ducts
Serum
Stents
Drainage
Sepsis
Databases
Prospective Studies
Control Groups

Keywords

  • Biliary duct carcinoma
  • Cholangiocarcinoma
  • Photodynamic therapy

ASJC Scopus subject areas

  • Biophysics
  • Oncology
  • Dermatology
  • Pharmacology (medical)

Cite this

@article{043474a09de444c5bdde232b95a6cabc,
title = "Photodynamic therapy for unresectable cholangiocarcinoma: A comparative effectiveness systematic review and meta-analyses",
abstract = "Background: Photodynamic therapy (PDT) with placement of a biliary stent may improve bile duct patency in patients with cholangiocarcinoma (CCA). We aimed to determine the effectiveness of biliary stenting with PDT compared to biliary stenting alone in the palliative treatment of CCA. Materials and methods: Several databases were searched from inception to December 2011 for prospective studies comparing biliary stenting with PDT vs. biliary stenting only for CCA. Outcomes of interest included patient survival, quality of life (using Karnofsky score), and serum bilirubin levels. The relative risk (RR) for dichotomous outcomes and the weighted mean difference (WMD) for continuous outcomes were estimated using DerSimonian and Laird random-effects model. Inconsistency was quantified using I2 statistics. The extent of publication bias was ascertained by visual inspection of funnel plots and Egger's test. Results: There were six studies that met inclusion criteria. A total of 170 participants received PDT and 157 had biliary stenting only. Compared with biliary stenting, PDT was associated with a statistically significant increase in the length of survival (WMD 265 days; 95{\%}CI: 154-376; p=0.01; I2=65{\%}), improvement in Karnofsky scores (WMD 7.74; 95{\%}CI: 3.73-11.76; p=0.01; I2=14{\%}), and a trend for decline in serum bilirubin (WMD -2.92mg/dL; 95{\%}CI: -7.54 to 1.71; p=0.22; I2=94{\%}). The pooled event rate for biliary sepsis was 15{\%} and was similar between PDT and control groups. Conclusion: Palliative treatment of CCA with PDT is associated with increased survival benefit, improved biliary drainage, and quality of life. However, the quality of this evidence is low.",
keywords = "Biliary duct carcinoma, Cholangiocarcinoma, Photodynamic therapy",
author = "Cadman Leggett and Gorospe, {Emmanuel C.} and Murad, {Mohammad H} and Montori, {Victor Manuel} and Baron, {Todd H.} and Wang, {Kenneth Ke Ning}",
year = "2012",
month = "9",
doi = "10.1016/j.pdpdt.2012.03.002",
language = "English (US)",
volume = "9",
pages = "189--195",
journal = "Photodiagnosis and Photodynamic Therapy",
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T1 - Photodynamic therapy for unresectable cholangiocarcinoma

T2 - A comparative effectiveness systematic review and meta-analyses

AU - Leggett, Cadman

AU - Gorospe, Emmanuel C.

AU - Murad, Mohammad H

AU - Montori, Victor Manuel

AU - Baron, Todd H.

AU - Wang, Kenneth Ke Ning

PY - 2012/9

Y1 - 2012/9

N2 - Background: Photodynamic therapy (PDT) with placement of a biliary stent may improve bile duct patency in patients with cholangiocarcinoma (CCA). We aimed to determine the effectiveness of biliary stenting with PDT compared to biliary stenting alone in the palliative treatment of CCA. Materials and methods: Several databases were searched from inception to December 2011 for prospective studies comparing biliary stenting with PDT vs. biliary stenting only for CCA. Outcomes of interest included patient survival, quality of life (using Karnofsky score), and serum bilirubin levels. The relative risk (RR) for dichotomous outcomes and the weighted mean difference (WMD) for continuous outcomes were estimated using DerSimonian and Laird random-effects model. Inconsistency was quantified using I2 statistics. The extent of publication bias was ascertained by visual inspection of funnel plots and Egger's test. Results: There were six studies that met inclusion criteria. A total of 170 participants received PDT and 157 had biliary stenting only. Compared with biliary stenting, PDT was associated with a statistically significant increase in the length of survival (WMD 265 days; 95%CI: 154-376; p=0.01; I2=65%), improvement in Karnofsky scores (WMD 7.74; 95%CI: 3.73-11.76; p=0.01; I2=14%), and a trend for decline in serum bilirubin (WMD -2.92mg/dL; 95%CI: -7.54 to 1.71; p=0.22; I2=94%). The pooled event rate for biliary sepsis was 15% and was similar between PDT and control groups. Conclusion: Palliative treatment of CCA with PDT is associated with increased survival benefit, improved biliary drainage, and quality of life. However, the quality of this evidence is low.

AB - Background: Photodynamic therapy (PDT) with placement of a biliary stent may improve bile duct patency in patients with cholangiocarcinoma (CCA). We aimed to determine the effectiveness of biliary stenting with PDT compared to biliary stenting alone in the palliative treatment of CCA. Materials and methods: Several databases were searched from inception to December 2011 for prospective studies comparing biliary stenting with PDT vs. biliary stenting only for CCA. Outcomes of interest included patient survival, quality of life (using Karnofsky score), and serum bilirubin levels. The relative risk (RR) for dichotomous outcomes and the weighted mean difference (WMD) for continuous outcomes were estimated using DerSimonian and Laird random-effects model. Inconsistency was quantified using I2 statistics. The extent of publication bias was ascertained by visual inspection of funnel plots and Egger's test. Results: There were six studies that met inclusion criteria. A total of 170 participants received PDT and 157 had biliary stenting only. Compared with biliary stenting, PDT was associated with a statistically significant increase in the length of survival (WMD 265 days; 95%CI: 154-376; p=0.01; I2=65%), improvement in Karnofsky scores (WMD 7.74; 95%CI: 3.73-11.76; p=0.01; I2=14%), and a trend for decline in serum bilirubin (WMD -2.92mg/dL; 95%CI: -7.54 to 1.71; p=0.22; I2=94%). The pooled event rate for biliary sepsis was 15% and was similar between PDT and control groups. Conclusion: Palliative treatment of CCA with PDT is associated with increased survival benefit, improved biliary drainage, and quality of life. However, the quality of this evidence is low.

KW - Biliary duct carcinoma

KW - Cholangiocarcinoma

KW - Photodynamic therapy

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U2 - 10.1016/j.pdpdt.2012.03.002

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JO - Photodiagnosis and Photodynamic Therapy

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