Davran R. Isametov

South Kazakhstan Medical Academy, Russia

Title: Intraarterial chemotherapy as an option for treating inoperative tumors of the hepatobiliary tract


The majority of malignant tumors of the hepatobiliary tract are cancers of the pancreas, liver, and gall bladder.
Pancreatic cancer and tumors today remain one of the most pressing aspects of clinical oncology. First of all, this is due to the fact that most patients at the time of initial diagnosis have the so-called advanced stage of the disease with metastases to parenchymal organs, or severe pain caused by tumor compression of the celiac trunk. The situation is similar with liver cholangiocarcinoma. The overall survival rate of this category of patients does not exceed 4-6 month survival rate according to world data. The data for our country is approximately identical.
The purpose of the study was to evaluate the possibilities of intra-arterial treatment methods as an option in the treatment of inoperable malignant tumors of the hepatobiliary zone.
Materials and methods. 20 patients aged from 36 to 58 years were treated. 8 patients with a verified diagnosis of liver cholangiocarcinoma, 12 patients with a primary diagnosis of pancreatic cancer of varying degrees of pain severity. In all patients, stage IV of the process was established (T4N1M1) with metastatic liver disease or intraorgan metastatic disease. According to the MDH recommendation, all patients are recommended to undergo courses of palliative polychemotherapy with elements of intra-arterial chemotherapy according to the “GEMOX” regimen in a standard therapeutic dose, with intra-arterial administration of Gemcitabine on the 1st day. The frequency of the procedure was carried out every 2-3 weeks, depending on the recovery of the blood picture. Most of the patients, almost 80%, noted grade 2-3 emetogenic reactions; in all cases, there was a transient increase in transaminase levels, which was manageably controlled by prescribing accompanying and symptomatic therapy.
Results and its discussion. According to the control examination, stabilization of the process with positive dynamics was noted in 10 (83.3%) patients with pancreatic cancer, 1 (8.3%) patient had partial regression, 1 (8.3%) patient had progression of the process against the background 3 courses of transarterial chemotherapy.
A decrease in pain was observed in 100% of cases after 1 course. 11 (91.6%) patients completed the full course of 6-8 cycles with stabilization of the process with a median survival of 6-8 months. Similarly, in patients with liver cholangiocarcinoma, the frequency of the procedure according to a similar “GEMOX” scheme was carried out once every 21 days, depending on the restoration of the peripheral blood pattern. The level of tumor markers CA 19-9 and the level of AFP decreased almost 2-fold after 1 course of transarterial chemotherapy. According to our observations, the median overall survival in this cohort of patients reached 2 years and 3 months in 2 patients who continue observation to this day.
Conclusions. The use of loco-regional treatments using transarterial chemotherapy reliably and clinically significantly increases the overall response rate, median survival and demonstrates an improvement in the quality of life of patients.

Key words: pancreatic cancer, cholangiocarcinoma, transtarterial chemotherapy.