Keywords
portal cholangiocarcinoma;
intraductal biopsy
videocholangioscopy
intraductal photodynamic therapy
chemoembolisation of hepatic arteries
regional chemoinfusion
How to Cite
Abstract
Introduction. The incidence of Klatskin Tumor (KT) continues to rise worldwide. Despite the development of surgical techniques and the emergence of new drugs, the results of diagnosis and treatment of this disease remain unsatisfactory.
Aim. To evaluate the efficacy of video-assisted intraductal biopsy and intraductal photodynamic therapy (iPDT) in combination with regional chemotherapy (RCT) in patients with KT.
Materials and methods. The results of treatment of 18 patients with KT treated in the Leningrad Regional Clinical Oncological Dispensary and in the Leningrad Regional Clinical Hospital (merged in 2023) from 2021 to November 2024 were evaluated. All patients following percutaneous transhepatic cholangiography (PTC). Bismuth-Corlette classification: IV — 8 (44 %); IIIa — 4 (22 %); IIIb — 5 (28 %) and II — 1 (6 %). 15 patients were examined using the original patented technique of video-assisted intraductal pinch biopsy under fluoroscopic guidance. A total of 45 sessions of iPDT (1 to 7 times) and 34 cycles of RCT (1 to 8 times) were conducted. A cylindrical diffuser was used in the original patented iPDT technique. RCT: chemoinfusion into the common hepatic artery according to the Gemcis or GemOx regimen (lipiodol + oxaliplatin during chemoembolization; n = 8). Three patients with a partial response underwent radical surgery. Three patients underwent stenting. Results were assessed by monitoring CA19-9, MSCT and MRI 4-6 weeks after every two combined cycles. Treatment was repeated after an average of 2.6 months.
Results. There were no complications. Currently, 7 patients (44 %) are alive between 3 and 43 months (mean 22 months) and their treatment is continuing. The actuarial survival rate for the 1-2-3 year period was 89 – 28 – 11 %. Ten (56 %) of 18 patients died between 14 and 24 months, mOS = 17.2 months. OS = 18 months.
Conclusion. Video-assisted intraductal pinch biopsy under fluoroscopic guidance is a safe and simple technique to achieve 100 % verification of the diagnosis of KT. The combination of iPDT and RCT improves survival (OS = 18 months) and may be effective as neoadjuvant therapy prior to extensive liver resection (relapse-free survival 28 months).
References
Banales J.M., Cardinale V., Carpino G., et al. Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA). Nature Reviews Gastroenterology & Hepatology. 2016; 13(5): 261-280.-DOI: https://doi.org/10.1038/nrgastro.2016.51.
Suarez-Munoz M.A., Fernandez-Aguilar J.L., Sanchez-Perez B., et al. Risk factors and classifications of hilar cholangiocarcinoma. World J Gastrointest Oncol. 2013; 5(7): 132.-DOI: https://doi.org/10.4251/wjgo.v5.i7.132.
Злокачественные новообразования в России в 2022 году (заболеваемость и смертность) / под ред. А.Д. Каприна и др. − М.: МНИОИ им. П.А. Герцена − филиал ФГБУ «НМИЦ радиологии» Минздрава России. 2023: 275. ISBN 978-5-85502-290-2.-URL: https://ri-systems.ru/tpost/97xc67ifr1-sbornik-zlokachestvennie-novoobrazovaniy.
Mocan T., Horhat A., Mois E., et al. Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: When and how? World J of Gastrointest Oncol. 2021; 13(12): 2050.-DOI: https://doi.org/10.4251/wjgo.v13.i12.2050.
Hameed A., Pang T., Chiou J., et al. Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma–a systematic review and meta-analysis. Hpb. 2016; 18(5): 400-410.-DOI: https://doi.org/10.1016/j.hpb.2016.03.002.
Ba Y., Yue P., Leung J.W., et al. Percutaneous transhepatic biliary drainage may be the preferred preoperative drainage method in hilar cholangiocarcinoma. Endosc Int Open. 2020; 8(2): E203-E210.-DOI: https://doi.org/10.1055/a-0990-9114.
Bismuth H., Corlette M.B. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet. 1975; 140(2): 170-178.-URL: https://pubmed.ncbi.nlm.nih.gov/1079096/
Chen X.P., Lau W.Y., Huang Z.Y., et al. Extent of liver resection for hilar cholangiocarcinoma. BJS. 2009; 96(10): 1167-1175.-DOI: https://doi.org/10.1002/bjs.6618.
DeOliveira M.L. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg. 2007; 245(5): 755-762.-DOI: https://doi.org/10.1097/01.sla.0000251366.62632.d3.
Bismuth H., Nakache R., Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg. 1992; 215(1): 31.-DOI: https://doi.org/10.1097/00000658-199201000-00005.
Saxena A., Chua T.C., Chu F.C., Morris D.L. Improved outcomes after aggressive surgical resection of hilar cholangiocarcinoma: a critical analysis of recurrence and survival. Am J Surg. 2011; 202(3): 310-320.-DOI: https://doi.org/10.1016/j.amjsurg.2010.08.041.
Liu Z.P., Chen W.Y., Zhang Y.Q., et al. Postoperative morbidity adversely impacts oncological prognosis after curative resection for hilar cholangiocarcinoma. World J Gastroenterol. 2022; 28(9): 948.-DOI: https://doi.org/10.3748/wjg.v28.i9.948.
Singhal D., Van Gulik T.M., Gouma D.J. Palliative management of hilar cholangiocarcinoma. Surg Oncol. 2005; 14(2): 59-74.-DOI: https://doi.org/10.1016/j.suronc.2005.05.004.
Бредер В.В., Базин И.С., Балахнин П.В., et al. Практические рекомендации по лекарственному лечению больных злокачественными опухолями печени и желчевыводящей системы. Практические рекомендации RUSSCO, часть 1. Злокачественные опухоли. 2023; 13(3s2): 494-538.-DOI: https://doi.org/10.18027/2224-5057-2023-13-3s2-1-494-538.
Shin D.W., Kim M.J., Lee J.C., et al. Gemcitabine plus cisplatin chemotherapy prolongs the survival in advanced hilar cholangiocarcinoma: a large multicenter study. Am J Clin Oncol. 2020; 43(6): 422-427.-DOI: https://doi.org/10.1097/COC.0000000000000682.
Zheng W.H., Yu T., Luo Y.H., et al. Clinical efficacy of gemcitabine and cisplatin-based transcatheter arterial chemoembolization combined with radiotherapy in hilar cholangiocarcinoma. World J Gastrointest Oncol. 2019; 11(6): 489.-DOI: https://doi.org/10.4251/wjgo.v11.i6.489.
Andrašina T., Válek V., Pánek J., et al. Multimodal oncological therapy comprising stents, brachytherapy, and regional chemotherapy for cholangiocarcinoma. Gut and Liver. 2010; 4(1): 82.-DOI: https://doi.org/10.5009/gnl.2010.4.S1.S82.
Zhang C., Song M., Sun Z., et al. Biliary drainage combined with simultaneous 125I seed strand brachytherapy for the treatment of hilar cholangiocarcinoma. BMC cancer. 2023; 23(1): 418.-DOI: https://doi.org/10.1186/s12885-023-10868-5.
Taggar A.S., Mann P., Folkert M.R., et al. A systematic review of intraluminal high dose rate brachytherapy in the management of malignant biliary tract obstruction and cholangiocarcinoma. Radiotherapy and Oncology. 2021; 165: 60-74.-DOI: https://doi.org/10.1016/j.radonc.2021.10.011.
Францев Д.Ю., Сергеева О.Н., Шориков М.А., Долгушин Б.И. Эндобилиарная фотодинамическая терапия у больных гилюсной холангиокарциномой часть 1: преклиническое обоснование применения метода. Диагностическая и интервенционная радиология. 2019; 13(4): 47-56.-DOI: https://doi.org/10.25512/DIR.2019.13.4.05.
Chen P., Yang T., Shi P., et al. Benefits and safety of photodynamic therapy in patients with hilar cholangiocarcinoma: A meta-analysis. Photodiagnosis Photodyn Ther. 2022; 37: 102712.-DOI: https://doi.org/10.1016/j.pdpdt.2022.102712.
Полысалов В.Н., Гапбаров А.Ч., Полехин А.С., Гранов Д.А. Комбинированное лечение нерезектабельной опухоли Клатскина с использованием внутрипротоковой фотодинамической терапии и регионарной химиотерапии. Вопросы онкологии. 2018; 64(4): 485-489.-URL: https://voprosyonkologii.ru/index.php/journal/article/view/867.
Полехин А.С., Филонов А.Л., Гапбаров А.Ч. Патент № 2801529 C1 Российская Федерация, МПК A61B 17/94, A61B 17/00, A61B 10/06. Способ чрескожной чреспеченочной щипковой внутрипротоковой биопсии: № 2022109821: заявл. 11.04.2022: опубл. 10.08.2023 - EDN QFCIUJ. URL: https://patenton.ru/patent/RU2801529C1.
Полысалов В.Н., Полехин А.С., Гапбаров А.Ч. Патент № 2753402 C1 Российская Федерация, МПК A61N 5/067. Способ фотодинамической терапии при лечении нерезекабельной аденокарциномы внепеченочных желчных протоков: № 2020113552: заявл. 15.04.2020: опубл. 16.08.2021; заявитель Федеральное государственное бюджетное учреждение «Российский научный центр радиологии и хирургических технологий имени академика А.М. Гранова» Министерства здравоохранения Российской Федерации. – EDN: UAXKDW. URL: https://patenton.ru/patent/RU2753402C1.
Ogawa T., Ito K., Koshita S., et al. Usefulness of cholangioscopic-guided mapping biopsy using SpyGlass DS for preoperative evaluation of extrahepatic cholangiocarcinoma: a pilot study. Endosc Int Open. 2018; 6(02): E199-E204.-DOI: https://doi.org/10.1055/s-0043-117949.
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