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Background: A palliative or symptomatic treatment is indicated for 7080% of patients with Klatskins tumor because of the advanced lesion volume and the patients grave condition. Hepatic arterial infusion chemotherapy, chemoembolization, radioembolization are successfully used in the treatment of hepatocellular carcinoma and liver metastases. Aim: to estimate the immediate and long-term results of photodynamic therapy (PDT) and its combination with hepatic arterial infusion in inoperable patients with Klatskin tumors. Methods: Between 2010 and 2021, 83 palliative PDT sessions (from 1 to 8, average 2.4) were performed in 82 patients as a single treatment or in combination with hepatic arterial infusion. In all cases, percutaneous transhepatic biliary drainage was previously performed; no chemotherapy was applied. Two groups of 48 patients were stratified according to the ECOG status (23) and the numbers of PDT sessions (no more than two). The treatment group of the combination therapy consisted of 24 patients (13 male, 11 female) aged 38 to 85 (mean 63) years with the ECOG status of 24 (mean 2.4). This group received PDT with hepatic arterial infusion using a GemCis regimen. On average, 1.4 PDT sessions were performed, the treatment started on the 89th (27225) day after the biliary drainage. The hepatic arterial infusion was performed on the 2d3th day after the PDT. The control group received only PDT and consisted of 24 patients (13 male, 11 female) aged 51 to 83 (66 on average) years, with the ECOG status of 23 (mean 2.6). On average, 1.4 PDT sessions were performed, starting on the 106th (32405) day after the biliary drainage. Results: There were no serious adverse events associated with PDT in both groups. Toxic complications of hepatic arterial infusion were observed in 13 of 24 patients (54%): III grade hematological (54%) and gastrointestinal (69%); all were eliminated with medical therapy. Complications of the percutaneous transhepatic biliary drainage in three patients (hemobilia, n=2, and sepsis, n=1) were estimated as grade III by the CIRSE classification (2017) and successfully treated without surgery. In the combination treatment group, the overall mean survival and median survival were higher than those in the control group: 327.939.8 days (10.9 mo) versus 246.931.2 days (8.2 mo) and 275 days versus 244 days. However, these differences did not reach the statistical significance (p=0.12). Conclusions: PDT is a safe method of a palliative treatment of critically ill patients with Klatskin tumor (ECOG 23). PDT alone has limited clinical efficacy. A combination of PDT and hepatic arterial infusion does not cause serious complications and may increase the survival rates.

The key element that has determined us to initiate a study concerning the benefits of intra-arterial chemotherapy is the fact that, despite progress regarding therapy, the ENT cancer prognosis is poor, especially in stages that have regional invasion, with a higher risk of therapeutic failure. ENT cancer treatment has raised many questions, the present therapeutic standard being simultaneous radio-chemotherapy with cisplatin, a quality regional control being obtained by hyper-fractionated radiotherapy, targeted on the tumour volume. The technical inconveniences that, in some cases, make impossible the accomplishment of a correct treatment, have determined us to make a retrospective analysis of the studies published in medical journals, with the aim of discerning a therapeutic method that has a role in increasing the loco-regional control of the disease. The studies speak about intra-arterial chemoinfusion with cisplatin, alongside radiotherapy, demonstrating with certainty the superiority of this method versus administrating the drug intravenously, in terms of local tumour control and tolerability. Because the benefits regarding the survival rate and the disease-free period have not reached the statistically significant level, intra-arterial chemoinfusion of cisplatin, alongside radiotherapy, remains a subject that is open to further studies. The efficacy of intra-arterial chemoinfusion of cisplatin hasn't been studied in the case of a relapse, remaining still a subject that is worthy of being approached, seeing as this method was shown to be efficient regarding the safety profile, having a good tolerability and also having a good activity profile, leading to increase in the quality of life and an increase in survival through a local tumour control that is superior than in the case of intravenous administration of the drug. [ABSTRACT FROM AUTHOR]