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Photodynamic Therapy in Unresectable Cholangiocarcinoma: Not for the Uncommitted
Jayant P. Talreja,Marisa DeGaetani,Kristi Ellen,Timothy Schmitt,Monica Gaidhane,Michel Kahaleh 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.4
Background/Aims: Photodynamic therapy (PDT) in unresectable cholangiocarcinoma has been associated with improved survival. We report a single tertiary care center experience over the past 6 years. Methods: Fifty-five patients with unresectable cholangiocarcinoma received PDT between 2004 and 2010. Plastic stents were placed after PDT to prevent cholangitis. Results: Twenty-seven patients (49%) showed Bismuth type IV, 22 (41%) showed Bismuth type III, and six (10 %) showed Bismuth type I and II. Twenty patients (37%) received chemotherapy and radiation therapy, five (9%) received chemotherapy only; and one (2%) received radiation therapy only. Mean number of PDT sessions was 1.9±1.5 sessions (range, 1 to 9). Mean survival duration was 293±266 days (median 190; range, 25 to 1,332). PDT related complications included three (5%) facial burn, three (5%) photosensitivity, and two (3%) rash. Kaplan-Meier analysis comparing the survival means of patients who received PDT and chemotherapy/radiation therapy (median survival 257 days; 95% confidence interval [CI], 166 to 528) versus who received PDT only (median survival 183 days; 95% CI, 129 to 224) showed no significant difference (log-rank p=0.20). Conclusions: PDT has a measurable impact on survival in unresectable cholangiocarcinoma but requires aggressive stenting post therapy.