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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Success of photodynamic therapy in palliating patients with nonresectable cholangiocarcinoma: A systematic review and meta-analysis
Harsha Moole, Harsha Tathireddy, Sirish Dharmapuri, Vishnu Moole, Raghuveer Boddireddy, Pratyusha Yedama, Sowmya Dharmapuri, Achuta Uppu, Naveen Bondalapati, Abhiram Duvvuri
Harsha Moole, Harsha Tathireddy, Department of Medicine, University of Illinois College of Medicine, Peoria, IL 61637, United States
Sirish Dharmapuri, Department of Medicine, Wilkes-Barre Veterans Affairs Medical Center, Scranton, PA 18711, United States
Vishnu Moole, Raghuveer Boddireddy, Pratyusha Yedama, Sowmya Dharmapuri, Department of Medicine, NTR University of Health Sciences, Andhra Pradesh 520008, India
Achuta Uppu, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, NY 10461, United States
Naveen Bondalapati, Department of Medicine, Barnes Jewish Christian Medical Group, Christian Hospital, St. Louis, MO 63136, United States
Abhiram Duvvuri, Division of Gastroenterology and Hepatology, Kansas City Veteran Affairs Medical Center, Kansas City, MO 64128, United States
Author contributions: Moole H contributed to conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article, critical revision, and final approval; Tathireddy H, Boddireddy R, Yedama P, Dharmapuri S, Uppu A and Bondalapati N contributed to acquisition of data, analysis and interpretation of data, drafting the article, final approval; Moole V and Dharmapuri S contributed to interpretation of data, revising the article, final approval; Duvvuri A contributed to conception and design of the study, critical revision, final approval.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Harsha Moole, MD, Clinical Associate, Department of Medicine, University of Illinois College of Medicine, Peoria, IL 61637, United States.
harsha1778@yahoo.co.in
Telephone: +1-309-6557257 Fax: +1-844-8936705
Received: June 21, 2016
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
Processing time: 244 Days and 10.3 Hours
AIM
To perform a systematic review and meta-analysis on clinical outcomes of photodynamic therapy (PDT) in non-resectable cholangiocarcinoma.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
