Open AccessPhotodynamic therapy with polyhematoporphyrin for malignant biliary obstruction: A nationwide retrospective study of 150 consecutive applications
Author(s) -
Dolak Werner,
Schwaighofer Hubert,
Hellmich Brigitte,
Stadler Bernhard,
Spaun Georg,
Plieschnegger Wolfgang,
Hebenstreit Arnold,
WeberEibel Jutta,
Siebert Franz,
Emmanuel Klaus,
Knoflach Peter,
Gschwantler Michael,
Vogel Wolfgang,
Trauner Michael,
Püspök Andreas
Publication year - 2017
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640616654037
Subject(s) - medicine , adverse effect , klatskin tumor , retrospective cohort study , stent , photodynamic therapy , therapeutic endoscopy , surgery , population , biliary tract , endoscopy , chemistry , environmental health , organic chemistry , resection
Background Photodynamic therapy (PDT) is a palliative treatment for malignant biliary obstruction. Objective The objective of this article is to assess the feasibility and safety of this technique. Methods In this nationwide, retrospective study of prospectively collected clinical data, all patients treated with PDT using polyhematoporphyrin in Austria from March 2004 to May 2013 were included. Feasibility, adverse events, stent patency and mortality rates were investigated. Results Eighty‐eight patients (54 male, 34 female, median age 69 years) underwent 150 PDT procedures at seven Austrian referral centers for biliary endoscopy. The predominant underlying disease was Klatskin tumor (79/88). All PDT procedures were feasible without technical issues. Cholangitis was the most frequent adverse event (21/88). Stent patency was 246 days (95% CI 203–289) median and was significantly longer for metal than for plastic stents (269 vs. 62 days, p < 0.01). The median survival was 12.4 months (95% CI 9.7–14.9 m) calculated from first PDT and 15.6 months (95% CI 12.3–18.7 m) calculated from initial diagnosis. In patients suffering from biliary tract cancer, Cox regression revealed the number of PDT treatment sessions as the only independent predictor of survival at a multivariate analysis ( p = 0.048). Conclusion PDT using polyhematoporphyrin was feasible and safe in this nationwide analysis. Survival data suggest a benefit of PDT in this unselected real‐life patient population. Prospective trials comparing PDT to other palliative treatments will help to define its role in the management of malignant biliary obstruction. The study is registered at ClinicalTrials.gov number: NCT02504957.