Meta Analyses Of Photodynamic Therapy For Unresectable Cholangiocarcinoma

Photodynamic therapy (PDT) combinedstent placement in biliary system may greatly improve bile duct drainage in patients diagnosed as cholangiocarcinoma.This study is designed to fully evaluate the effectiveness of biliary stenting with PDT compared to biliary stenting alone in the palliative treatment of cholangiocarcinoma.Methods:Several databases were searched from inception to December2011for prospective studies comparing biliary stenting with PDT vs. biliary stenting only for CCA. Outcomes of interest included patient survival, quality of life (using Karnofsky score), and serum bilirubin levels. The relative risk (RR) for dichotomous outcomes and the weighted mean difference (WMD) for continuous outcomes were estimated using DerSimonian and Laird random-effects model. Inconsistency was quantified using12statistics. The extent of publication bias was ascertained by visual inspection of funnel plots and Egger’s test.Results:There were six studies that met inclusion criteria. A total of170participants received PDT and157had biliary stenting only. Compared with biliary stenting, PDT was associated with a statistically significant increase in the length of survival (WMD265days;95%CI: 154-376；p=0.01；12=65%),improvement in Karnofsky scores(WMD7.74；95%CI:3.73-11.76；p=0.01；I2=14%),and a trend for decline in serum bilirubin(WMD-2.92mg/dL；95%CI:-7.54to1.71；p=0.22；12=94%).The pooled event rate for biliary sepsis was15％and was similar between PDT and control groups.Conclusion:Palliative treatment of CCA with PDT is associated with increased survival benefit,improved biliary drainage,and quality of life.However,the quality of this evidence is low.