Intra-arterial chemotherapy in the treatment of inoperable patients with Klatskin tumor: preliminary results

Background: Surgical resection is the treatment of choice for Klatskin tumor, when possible, but unfortunately, many patients present with the late-stage and unresectable disease. A large number of studies have confirmed that arterial chemotherapy is safe and effective for the palliative treatment of primary and secondary hepatic malignancies. Aim: To evaluate the safety and efficacy of hepatic arterial infusion in patients with Klatskin tumor. Methods: Between 2010 and 2021, 14 of 119 patients with inoperable Klatskin tumor were treated with hepatic arterial infusion of GemCis at the A.M. Granov RRCRST. All the patients had obstructive jaundice and received percutaneous transhepatic biliary drainage. Chemotherapy was started when the serum bilirubin level became normal (averagely on the 106th day from percutaneous transhepatic biliary drainage). In total, 19 (from 1 to 4 per patient) hepatic arterial infusion cycles were performed. Results: Percutaneous transhepatic biliary drainage complications such as cholangitis (n=2) and local peritonitis (n=1) developed in 3 patients (21%) and were successfully treated using minimally invasive techniques. The toxicity of chemotherapy was observed in 8 of 14 patients (57%): I–II degree hematological toxicity (43%) and gastrointestinal toxicity (50%); these complications were cured by medical therapy. The overall mean survival was 286 days (9.6 months), the median survival was 283 days (9.4 months). Conclusions: Our preliminary results show that hepatic arterial infusion in patients with Klatskin tumor is safe, but has limited effectiveness. The combination of arterial infusion with other methods such as radiotherapy, intra-ductal photodynamic therapy, radiofrequency ablation, target therapy, should be investigated.