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Meta-Analysis
. 2017 Feb 21;23(7):1278-1288.
doi: 10.3748/wjg.v23.i7.1278.

Success of photodynamic therapy in palliating patients with nonresectable cholangiocarcinoma: A systematic review and meta-analysis

Harsha Moole  1 , Harsha Tathireddy  1 , Sirish Dharmapuri  1 , Vishnu Moole  1 , Raghuveer Boddireddy  1 , Pratyusha Yedama  1 , Sowmya Dharmapuri  1 , Achuta Uppu  1 , Naveen Bondalapati  1 , Abhiram Duvvuri  1
Affiliations
Meta-Analysis

Success of photodynamic therapy in palliating patients with nonresectable cholangiocarcinoma: A systematic review and meta-analysis

Harsha Moole et al. World J Gastroenterol. .

Abstract

Aim: To perform a systematic review and meta-analysis on clinical outcomes of photodynamic therapy (PDT) in non-resectable cholangiocarcinoma.

Methods: Included studies compared outcomes with photodynamic therapy and biliary stenting (PDT group) vs biliary stenting only (BS group) in palliation of non-resectable cholangiocarcinoma. Articles were searched in MEDLINE, PubMed, and EMBASE. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using the I2 statistic.

Results: Ten studies (n = 402) that met inclusion criteria were included in this analysis. The P for χ2 heterogeneity for all the pooled accuracy estimates was > 0.10. Pooled odds ratio for successful biliary drainage (decrease in bilirubin level > 50% within 7days after stenting) in PDT vs BS group was 4.39 (95%CI: 2.35-8.19). Survival period in PDT and BS groups were 413.04 d (95%CI: 349.54-476.54) and 183.41 (95%CI: 136.81-230.02) respectively. The change in Karnofsky performance scores after intervention in PDT and BS groups were +6.99 (95%CI: 4.15-9.82) and -3.93 (95%CI: -8.63-0.77) respectively. Odds ratio for post-intervention cholangitis in PDT vs BS group was 0.57 (95%CI: 0.35-0.94). In PDT group, 10.51% (95%CI: 6.94-14.72) had photosensitivity reactions that were self-limiting. Subgroup analysis of prospective studies showed similar results, except the incidence of cholangitis was comparable in both groups.

Conclusion: In palliation of unresectable cholangiocarcinoma, PDT seems to be significantly superior to BS alone. PDT should be used as an adjunct to biliary stenting in these patients.

Keywords: Biliary stenting; Meta-analysis; Outcome; Photodynamic therapy; Systematic review; Unresectable cholangiocarcinoma.

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Conflict of interest statement

Conflict-of-interest statement: The authors deny any conflict of interest.

Figures

Figure 1
Figure 1
Study selection. PDT: Photodynamic therapy.
Figure 2
Figure 2
Forest plot - individual study proportions and the pooled estimate of survival period in photodynamic therapy group.
Figure 3
Figure 3
Funnel plot: Survival in photodynamic therapy group.
Figure 4
Figure 4
Forest plot - individual study proportions and the pooled estimate of change in Karnofsky performance scores in photodynamic therapy group.
Figure 5
Figure 5
Forest plot - individual study proportions and the pooled estimate of odds ratio - successful biliary drainage in photodynamic therapy group vs biliary stenting group.
Figure 6
Figure 6
L’Abbe plot for odds ratio - successful biliary drainage in photodynamic therapy group vs biliary stenting group.
Figure 7
Figure 7
Forest plot - individual study proportions and the pooled estimate of odds ratio - cholangitis in photodynamic therapy group vs biliary stenting group.
Figure 8
Figure 8
Funnel plot - odds ratio for cholangitis in photodynamic therapy group vs biliary stenting group.
Figure 9
Figure 9
Forest plot - individual study proportions and the pooled estimate of photosensitivity reactions in photodynamic therapy group.
See this image and copyright information in PMC

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