Photodynamic therapy plus chemotherapy can improve survival in unresected extrahepatic cholangiocarcinoma (ECC) without increasing the rate of adverse events, found a new study published in the journal Photodiagnosis and Photodynamic Therapy.

The approach “may be a potential standard therapy in the future management of ECC,” the study authors noted.

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To assess the safety and efficacy of photodynamic therapy combined with chemotherapy in patients with unresected ECC, a disease that is highly invasive and for which no ideal treatments exist, a team of researchers from China conducted a systematic review of the literature.

The researchers identified 7 studies to compare photodynamic therapy plus chemotherapy to photodynamic therapy alone or chemotherapy alone. Of these 7 studies, 4 compared photodynamic therapy plus chemotherapy to chemotherapy alone, while 3 studies compared photodynamic therapy plus chemotherapy to photodynamic therapy alone. 

The meta-analysis showed that photodynamic therapy combined with chemotherapy led to significantly better overall survival compared to chemotherapy or photodynamic therapy alone. 

In terms of side effects such as cholangitis, abscess, and photosensitivity reaction, all 3 approaches were comparable.

The authors concluded that a combination of photodynamic therapy and chemotherapy could be the standard therapy for unresected ECC “after a complete evaluation of cost-benefit ratios.” However, they warned that it is important to be cautious when using this approach in the clinic as evidence is still limited at this point.

Photodynamic therapy is a local therapy that uses the photosensitizer within the tumor to generate reactive oxygen species that can lead to tumor necrosis and programmed cell death.  

ECC is a subtype of cholangiocarcinoma that is particularly hard to diagnose due to the inability of current screening methods to detect it and because the disease does not have any particular symptoms. The only curative option is surgery, but around 65% of patients are not eligible.


Yu Y, Wang N, Wang Y, et al. Photodynamic therapy combined with systemic chemotherapy for unresectable extrahepatic cholangiocarcinoma: a systematic review and meta-analysis. Photodiagnosis Photodyn Ther. Published online February 7, 2023. doi:10.1016/j.pdpdt.2023.103318