Photodynamic therapy prolongs metal stent patency in patients with unresectable hilar cholangiocarcinoma

AIM： TO evaluate the effect of photodynamic therapy （PDT） on metal stent patency in patients with unre- sectable hilar cholangiocarcinoma （CC）. METHODS： This was a retrospective analysis of pa- tients with hilar CC referred to our institution from December, 1999 to January, 2011. Out of 232 patients, thirty-three patients with unresectable hilar CC were treated. Eighteen patients in the PDT group were treat- ed with uncovered metal stents after one session of PDT. Fifteen patients in the control group were treated with metal stents alone. Porfimer sodium （2 mg/kg） was administered intravenously to PDT patients. Forty- eight hours later, PDT was administered using a diffus- ing fiber that was advanced across the tumor by either endoscopic retrograde cholangiopancreatography or percutaneous cholangiography. After performance of PDT, uncovered metal stents were inserted to ensure adequate decompression and bile drainage. Patient sur- vival rates and cumulative stent patency were calculated using Kaplan-Meier analysis with the log-rank test. RESULTS： The PDT and control patients were compa- rable with respect to age, gender, health status, pre- treatment bilirubin, and hilar CC stage, When com- pared to control, the PDT group was associated with significantly prolonged stent patency （median 244±66 and 177±45 d, respectively, P = 0.002） and lon- ger patient survival （median 356 ± 213 and 230 ± 73 d, respectively, P = 0.006）. Early complication rates were similar between the groups （PDT group 17%, control group 13%） and all patients were treated conserva- tively. Stent malfunctions occurred in 14 PDT patients （78%） and 12 control patients （80%）. Of these 26 patients, twenty-two were treated endoscopically and four were treated with external drainage. CONCLUSION： Metal stenting after one session of PDT may be safe with acceptable complication rates, The PDT group was associated with a significantly lon- ger stent patency than the control group in patients with unresectable hilar CC.