A Systematic Review Of Non-Surgical Therapies For Nonresectable Bile Duct Cancer

Bile duct cancer, also called cholangiocarcinoma, is one kind malignant tumour with low incidence in extrahepatic bile duct from ieft and right hepatic duct to common bile duct. The main reason of death is progressive damage caused by hepatorenal function or complicates including bile duct infection, live abscess, etc. The key of treating the bile duct cancer is to control development of the tumour and to keep the duct open.Currently the treatment approaches for nonresectable bile duct cancer include :(1). Palliative operator for the purpose of dispelling the obstructive icterus, duodenum obstruction and release the pain; (2). Smaller the tumour body by closely radiotherapy and chemotherapy in the inner cavity for purpose of avoiding translating to lymph node and other organisms; (3). Using photodynamic theratpy to kill the tumour cell, attenuating the obstruction and compression on the duct; (4). Other palliation therapies include stenting combine oriented radiotherapy or chemotherapy or integrated traditional Chinese medicine and Western medicine, etc.To assess the benefits and possible harms of non-surgical treatments in the treatment of nonresectable bile duct cancer, we are particularly interested on the survival, quality of life, cost-effect.Materials and methods1 Search strategyWe searched Medline and OVID (1966 to 2, 2007), CENTRAL in the Cochrane Library( issue 1, 2007), CBMdisc (1978 to 2, 2007) both VIP and CNKI (1979 to 2, 2007). Compute-based searches were supplemented by manual searching of related journals and proceedings meeting search strategy.Two authors appraisal the quality of included studies, and performed meta-analysis for studies with homogeneity.2 Including criteriaAny article who mentioned "randomized controlled trial", "randomly allocation" studies treating nonresectable bile duct cancer by stenting, photodynarnic therapy, interventional treatment, integrated traditional Chinese medicine and Western medicine (conventional medicine), were considered eligible.3 Data collection and analysisOne author collecting the data and selecting for studies.ResultsThis review is conducted as three subtopics: (1) Photodynamic therapy for nonresectable bile duct cancer; (2) Systematic chemotherapy for nonresectable bile duct cancer;(3)Stenting palliation therapy for nonresectable bile duct cancer.1 Characteristics of Included studies(1) Photodynamic therapy for nonresectable bile duct cancer: two studies including 102 patients with nonresectable bile duct cancer were included. (2)Systematic chemotherapy for nonresectable bile duct cancer: three studies including 163 patients with advanced nonresectable bile duct cancer were included;(3)Stenting palliation therapy for nonresectable bile duct cancer: three studies including 80 patients with advanced nonresectable bile duct cancer were included.2 Analysis results2.1 Photodynamie therapy for nonreseetable bile duet cancerThere is obviously benefit in survival or number of survival in those who treated by photodynamic therapy for nonresectable bile duct cancer. In Ortner 2003 study and Zoepf 2005 study, the median survival time was 493 days (95%CI 276 to 710), 21 months in photodynamic therapy group, respectively; and 98 days (95%CI 87 to 107), 7 months in stenting group, respectively. The global quality of life in photodynamic therapy group in study Ortner 2003 was found that obviously better than that in stenting group; the functional indicators such as body function, motion, cognition, harmonization, symptOms include loss of weight, fever, sleep disturbance, etc, also presented obviously superior than those who treated by stenting. 2.2 Comparison of differentschemes "chemotherapy for nonresectable bile duct cancer One study found that the median survival was 5 months (95%CI 4.0 to 7.4) in patients with bile duct cancer treated by HDFU, and 8 months (95%CI 5.8 to 11.8) in those treated by 5FU+FA+CDDP, there was statistically significantly difference (P<0.01). Other two studies found that there was no statistically significant different between different chemotherapy schemes on survival or alive time, also on quality of life, adverse effects.2.3 Stenting palliation therapy for nonresectable bile duet cancer Only one study didn't provide evidence of that mean survival longer in the stenting group than in by-pass operation. There was obviously effect on reducing icterus in the patient treated by stent, but there was no difference with by-pass operation. There was still no evidence "to demonstrate that the stenting is better than by-pass operation on improvement of quality of life.ConclusionStrong evidence demonstrated that photodynamic therapy can obviously improve survival time or rate of survival and quality of life of patients with nonresectable bile duct cancer. There was no evidence of that interventional chemotherapy can improve the survival time of patients with bile duct cancer due to the reported data were similar as those patients without treatment. The various effects were similar between various stentings in the treatment of bile duct obstruction caused by malignant tumour. Stenting can decrease jaundice of cholangiocarcinoma patients obviously, but comparing with by-pass operation, it does not statistical difference significantly. There was still no evidence to demonstrate that the stenting can improve patient's quality of life.Poor quality of methodology and design were the common limitations in trials conducted in China. It is expected that further trials should pay attention to improve the quality of both the design and performance for the purpose of providing high quality evidence in the future.