Percutaneous transhepatic cholangioscopy (PTCS)-guided photodynamic therapy (PDT) appears to increase survival and improve overall quality of life in patients with postoperative cholangiocarcinoma (CCA) recurrence, according to an article recently published in Photodiagnosis and Photodynamic Therapy.

Although surgical resection is the preferred treatment for CCA, the majority of patients have advanced disease at the time of diagnosis and are not eligible for surgery; furthermore, the 5-year survival after partial liver resection is less than 40%. 

Palliative treatments such as chemotherapy, radiotherapy, and percutaneous transhepatic biliary drainage (PTCD) do not appear to increase survival or inhibit tumor growth significantly.


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But according to several studies, PDT shows promise as an alternative palliative treatment with the capacity to improve survival and quality of life. However, there is scarce evidence regarding its effectiveness in the context of postoperative CCA recurrence or possible complications in these patients.

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The authors aimed to assess the efficacy of PTCS-guided PDT through a retrospective study including 39 patients with CCA recurrence after surgery. Of the included population, 18 patients received PTCS-guided PDT and 21 received only PTCD. 

The primary endpoints of the study were survival time, defined as the interval between the beginning of treatment and death, and quality of life, determined using the Functional Assessment of Cancer Therapy–Hepatobiliary (FACT-HEP) questionnaire. Both groups of patients were compared using Kaplan-Meier analysis and a log-rank test.

Median survival was significantly longer in the PDT group than in the PTCD group. After 12 months, survival in the PDT group was close to 90%, while survival in the PTCD group was around 40%. At 24 months, these survival rates decreased to 50% and 0%, respectively. After 36 months, survival in the PDT group was over 30%.

Three months after treatment, there was no significant difference in quality of life. However, after 6 and 12 months, quality of life was significantly higher in the PDT group.

There was no significant difference in the incidence of adverse effects between both groups; common adverse effects included phototoxicity and biliary bleeding. 

“PTCS-guided PDT can prolong the survival time and improve the quality of life of patients with postoperative recurrent cholangiocarcinoma without increasing adverse events risk,” the authors concluded. 

Reference

Chen Z, Jiang X, Xue P, et al. Long-term efficacy of percutaneous transhepatic cholangioscopy-guided photodynamic therapy for postoperative recurrent extrahepatic cholangiocarcinoma. Photodiagnosis Photodyn Ther. Published online September 14, 2022. doi:10.1016/j.pdpdt.2022.103122