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

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 I-2 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; I-2 = 65%), improvement in Karnofsky scores (WMD 7.74; 95%CI: 3.73-11.76; p = 0.01; I-2 = 14%), and a trend for decline in serum bilirubin (WMD -2.92 mg/dL; 95%CI: -7.54 to 1.71; p = 0.22; I-2 = 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. (C) 2012 Elsevier B.V. All rights reserved.