Combination Therapy Doubles Liver Cancer Survival

Adding photodynamic therapy (PDT) to stents can improve survival in patients with unresectable cholangiocarcinoma, according to a new study.

Researchers of the University of Virginia (Charlottesville, USA) compared a group of 48 patients with unresectable cholangiocarcinoma undergoing endoscopic retrograde cholangiopancreatography (ERCP) with PDT and stent placement with a group undergoing ERCP with stent placement alone during a 5-year period. Nineteen patients were treated with PDT and stents; the other 29 patients treated with biliary stents alone and served as a control group. Multivariate analysis was performed by using the model for end-stage liver-disease score, age, treatment by chemotherapy or radiation, and number of ERCP procedures and PDT sessions to detect predictors of survival.

The results showed improved survival in the PDT group compared with the stent only group (16.2 versus 7.4 months). Mortality in the PDT group at 3, 6, and 12 months was 0%, 16%, and 56%, respectively. The corresponding mortality in the stent group was 28%, 52%, and 82%, respectively. The difference between the two groups was significant at 3 months and 6 months, but not at 12 months. The results showed that only the number of ERCP procedures and number of PDT sessions were significant on multivariate analysis. Adverse events specific to PDT included three patients with skin phototoxicity requiring topical therapy only. The study was published in the March 2008 issue of Clinical Gastroenterology and Hepatology.

"ERCP with PDT seems to increase survival in patients with unresectable cholangiocarcinoma when compared with ERCP alone,” concluded lead author Michel Kahaleh, M.D., and colleagues of the digestive health center. "It remains to be proved whether this effect is attributable to PDT or the number of ERCP sessions.”

Photodynamic therapy is an ablative treatment; a photosensitizing drug is first administered, which is followed by a wavelength of light. This promotes intracellular activation of the drug and cellular injury by thrombosis of vessels and a subsequent immune response that can lead to the destruction of the tumor. The procedure is time consuming and can be quite prolonged, depending on number of segments treated; however, PDT, which is considered standard treatment in Europe, has been associated with improvement in cholestasis, quality of life, and potentially survival for patients with unresectable cholangiocarcinoma.


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