ERCP-directed radiofrequency ablation and photodynamic therapy are associated with comparable survival in the treatment of unresectable cholangiocarcinoma

Daniel S. Strand, Natalie D. Cosgrove, James T. Patrie, Dawn G. Cox, Todd W. Bauer, Reid B. Adams, James A. Mann, Bryan G. Sauer, Vanessa M. Shami, Andrew Y. Wang

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82 Scopus citations


Background: Cholangiocarcinoma (CCA) is a malignancy with a poor 5-year survival rate (5%-10%). ERCPdirected radiofrequency ablation (RFA) or photodynamic therapy (PDT) can be performed as palliative therapy for unresectable CCA. ERCP with PDT is associated with improved survival compared with stent placement alone. However, ERCP-directed RFA has not been directly compared with PDT in patients with CCA. Objective: To compare overall survival in patients with unresectable CCA who underwent palliative ERCPdirected RFA versus PDT. Design: Retrospective cohort study. Setting: Tertiary-care academic medical center. Patients: Forty-eight patients with unresectable CCA who underwent ERCP-directed ablative therapy for palliation of unresectable CCA. Interventions: ERCP-directed RFA or PDT. Main Outcome Measurements: Overall survival by Kaplan-Meier analysis after initial treatment with either RFA or PDT. Results: Patients who underwent RFA (n Z 16) demonstrated an overall survival similar to that of those who underwent PDT (n Z 32), with a median survival of 9.6 versus 7.5 months, respectively (P Z .799). Patient age (P Z .45), sex (P Z .52), and lead time (P Z .59) from presentation to initial RFA or PDT had no significant association with survival. The presence of distant metastasis was inversely associated with survival (hazard ratio 3.55; 95% confidence interval, 1.29-9.77; P Z .014). Patients who underwent RFA (compared with PDT) had a lower mean number of plastic stents placed per month (0.45 vs 1.10, P Z .001) but also had more episodes of stent occlusion (0.06 vs 0.02, P Z .008) and cholangitis (0.13 vs 0.05, P Z .008) per month. Limitations: Retrospective, single-center design. Conclusions: Survival after ERCP-directed RFA and PDTwas not statistically different in patients with unresectable CCA. A randomized, controlled trial is warranted to validate these preliminary results.

Original languageEnglish
Pages (from-to)794-804
Number of pages11
JournalGastrointestinal endoscopy
Issue number5
StatePublished - Jan 1 2014


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