Combined treatment for Klatskin non-resectable tumor using intra-flow photodynamic therapy and regional chemotherapy

Abstract

The experience of treatment of 28 patients with Klatskin tumor is summarized. Bile ducts tumor of stages III-IV was diagnosed in 25 patients. A total of 97 sessions of intra-flow photodynamic therapy and 74 courses of regional chemotherapy were conducted. One patient due to a full response to treatment there was performed orthotopic liver transplantation from a cadaver donor. In all observations the diagnosis was confirmed morphologically by means of intra-flow biopsy or after investigation of the removed specimen. All patients at the time of the beginning of treatment underwent percutaneous cholangiodrainage. Intra-flow photodynamic therapy was performed in the dose-fractionation mode by the "LAKHTA-MILON" diode laser device using quartz optic fiber systems and a catheter with a cylindrical diffuser at a radiation power at the fiber output of one watt. The density of the supplied energy was 200 J/cm2. Radachlorin or Photon preparations were used as photosensitizers. Subsequently, in 2-4 days, visceral angiography of the hepatopancreatoduodenal zone with the arterial catheter inserted into the celiac trunk or the common hepatic artery to carry out regional chemotherapy by GemOx mode was performed. 21 (71,4%) patients died at the time from 8 to 42 months. 7 (28.6%) patients who undergo repeated courses of combined treatment at intervals of 1,5 to 3 months are alive and under observation from 10 to 26 months. The median survival is 21 months, the average life span is 15,4 + 0,8 months. A one-year survival rate is 78%, a two-year survival rate - 18%, a three-year survival rate - 4%. Survival of patients (according to Kaplan-Meier) is 18 months.