Liver Cancer — Embolization or Chemoembolization: treatment in the Best Hospitals in the World
Prof. Dr. med. Thomas Vogl is Professor and Head of the Department of Adult and Pediatric Diagnostic and Interventional Radiology at the University Hospital Frankfurt-am-Main. He conducts online consultations about the possibility of treatment of stage 4 cancer in Germany.
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Department of Interventional Radiology
The Department of Interventional Radiology offers the full range of imaging examinations, as well as innovative image-guided minimally invasive techniques for the treatment of tumors, vascular diseases and internal pathologies (for example, CT, MRI, PET-CT, SPECT). The department's doctors have deep knowledge and colossal experience in the field of interventional radiological methods of treatment, which represent an excellent alternative to open surgical interventions. Despite the high level of technical equipment and the presence of advanced computerized systems, the focus is always on the person with his individual needs. Compliance with current clinical protocols and high professionalism of the department's specialists contribute to the successful clinical practice, as well as the reputability of the department among the best medical facilities of this kind in Germany.
Department of Adult and Pediatric Diagnostic, Interventional Radiology, Neuroradiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology, Neuroradiology offers the full range of modern radiological diagnostics and minimally invasive treatment both on an inpatient and outpatient basis. It has advanced equipment for conducting radiological studies in adults and children, as well as minimally invasive procedures under the guidance of imaging systems. There is maintained close cooperation with many departments of the hospital, which provides an interdisciplinary approach to treatment and comprehensive medical care.
Department of Adult and Pediatric Diagnostic, Interventional Radiology, Neuroradiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology, Neuroradiology is one of the best institutions of its kind in Germany and offers patients the full range of radiological studies and imaging-guided minimally invasive therapy. The department’s scope of tasks also includes imaging diagnostics in children of all age groups, detection and invasive treatment of cerebral vascular pathology (neuroradiology). Patient care is provided both on an inpatient and outpatient basis.
Department of Interventional Neuroradiology
The Department of Interventional Neuroradiology offers the full range of services in the areas of its specialization. The medical facility provides imaging diagnostics and low-traumatic image-guided interventional treatment of nervous system diseases. The department's specialists have rich experience and exceptional professional skills in the field of interventional procedures for acute and chronic vascular diseases, such as ischemic strokes, brain hemorrhages, cerebral artery stenosis, brain aneurysms, and vascular malformations. The department's neuroradiologists cooperate closely with neurologists and neurosurgeons so that each patient receives an optimal treatment regimen based on the expert opinions of the specialists. The department's medical team has state-of-the-art computed tomography (CT), magnetic resonance imaging (MRI), and MR angiography systems that are actively used for diagnosing patients and therapeutic procedures. Medical care is provided in compliance with current clinical protocols. The department also offers many outpatient medical services, which is an advantage for many patients.
Department of Neuroradiology
The Department of Neuroradiology provides the full range of diagnostic and therapeutic services in the areas of its specialization. The team of the department's doctors deals with the diagnostics and treatment of brain and spinal cord pathologies. The department has at its disposal state-of-the-art medical equipment, including systems for CT, MRI and myelography, thanks to which specialists can comprehensively assess the state of the nervous system, detect pathological processes at the initial stages and provide effective treatment. Among the department's therapeutic options, a special focus is on the interventional treatment of acute stroke – thrombectomy. Another important focus of the specialists' work is the treatment of cerebral vascular malformations, stenosis of the arteries of the brain and spinal cord, and cerebral aneurysms. In addition, the department provides CT-guided interventional pain management to relieve chronic back pain. The department's neuroradiologists cooperate closely with doctors from the related medical specialties: neurologists, neurosurgeons, ophthalmologists, otolaryngologists and radiation therapists. The specialists strive to provide each patient with high quality medical care meeting his needs and wishes.
Department of Adult and Pediatric Diagnostic, Interventional Radiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology offers the full range of services in these medical fields. To ensure the accurate diagnostics and effective treatment, the department has state-of-the-art medical equipment, particularly 64-slice CT scanner, two 1.5 Tesla high-performance MRI devices, modern equipment for digital subtraction angiography (DSA), pulsed fluoroscopy and many other devices. All medical services are carried out in strict accordance with the protocols of professional societies.
Department of Adult and Pediatric Diagnostic, Interventional Radiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology offers the full range of medical services in these fields. In order to ensure the most accurate and reliable diagnostics, the department has state-of-the-art systems for CT, MRI, PET, ultrasound and X-ray examinations, as well as PET-CT and SPECT-CT hybrid examinations. The department specializes in interventional radiology, namely, imaging-guided therapy. It performs all vascular (for example, vascular recanalization) and non-vascular imaging-guided interventions (for example, tumor ablation). The department is one of the largest and leading medical facilities of this kind in Europe.
Department of Adult and Pediatric Interventional Radiology, Neuroradiology
The Department of Adult and Pediatric Interventional Radiology, Neuroradiology specializes in modern imaging examinations and minimally traumatic image-guided interventional procedures. Of particular interest to the department's experienced medical team is individualized minimally invasive therapy for cancer and the treatment of pain syndromes and vascular pathologies. The medical facility has state-of-the-art equipment for X-ray scanning, angiography, ultrasound scanning, CT, MRI, and PET/MRI. The diagnostic devices are adapted for children, including newborns. During examinations and treatment, the department's specialists strictly meet radiation protection standards. As for treatment, special attention in clinical practice is paid to interventional procedures for vascular diseases and malignant tumors. These procedures are performed using catheter-based techniques under CT, MRI, or angiography guidance. Despite the low trauma rate of interventional manipulations, their effectiveness is comparable to full-fledged surgery. The medical facility cooperates closely with other departments at the hospital, thus providing comprehensive medical care at the highest level of university medicine. The department's successful clinical practice has been recognized by prestigious quality certificates, including the ClarZert certificate and certificates from the German Cancer Society (DKG) and the German Radiological Society (DRG).
Department of Adult and Pediatric Diagnostic, Interventional Radiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology provides the full range of services in these fields and specializes in conducting radiologic examinations, high-intensity focused ultrasound (HIFU) therapy, vascular, oncological, orthopedic and urologic interventions. The department includes specialized Sections for Gynecologic, Pediatric and Orthopedic Radiology.
Department of Adult and Pediatric Diagnostic Radiology, Interventional Radiology and Neuroradiology
The Department of Adult and Pediatric Diagnostic Radiology, Interventional Radiology and Neuroradiology offers the full range of modern radiological examinations and minimally invasive imaging-guided treatment of various diseases. Most often, radiologists have to deal with the diagnostics and therapy of tumors, inflammatory processes, injuries, pathologies of the heart and vascular diseases. The combination of advanced medical technologies and high professionalism of the doctors working in the department are the key to the successful treatment results.
University Hospital of Ludwig Maximilian University of Munich
Department of Adult and Pediatric Interventional Radiology
The Department of Adult and Pediatric Interventional Radiology provides the full range of medical services in the area of its specialization. The department offers modern diagnostic rooms with advanced equipment for imaging examinations for patients with suspected cancer, diseases of the cardiovascular system, thorax, abdominal organs, musculoskeletal system, and breast diseases. The department's diagnostic systems are adapted for examining children of different age groups. The medical facility also offers many therapeutic services, the most popular of which include MRI-guided treatment of uterine fibroids with high-intensity focused ultrasound (HIFU) and uterine artery embolization, prostate adenoma treatment with prostate artery embolization, tumor treatment with brachytherapy, percutaneous radiofrequency ablation, percutaneous microwave ablation, and transarterial chemoembolization. The doctors working at the medical facility also have rich experience in the interventional treatment of vascular pathologies and arteriovenous malformations. The department has an excellent reputation and regularly diagnoses and treats patients not only from Germany but also from other countries in the world.
Department of Adult and Pediatric Diagnostic, Interventional Radiology, Neuroradiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology, Neuroradiology offers the full range of services in these medical fields. Here patients can undergo all modern imaging diagnostic studies and therapeutic procedures, the quality of which corresponds to high international standards. The department also specializes in conducting radiological studies in children and adolescents. The cutting-edge technical equipment and the rich clinical experience of doctors contribute to the successful work of the department.
Department of Adult and Pediatric Diagnostic Radiology, Interventional Radiology
The Department of Adult and Pediatric Diagnostic Radiology, Interventional Radiology offers the full range of services in these fields. It conducts all types of modern imaging studies: sonography, digital X-ray, angiography, multilayer computed tomography and conventional MRI, positron emission tomography (PET/CT), etc. The department also specializes in minimally invasive treatment of various tumors, vascular pathology (obstruction and vascular stenosis). The Section of Experimental Radiology is engaged in active research to optimize existing methods and develop new ones.
Department of Adult and Pediatric Diagnostic, Interventional Radiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology offers the full range of modern diagnostic and therapeutic procedures in this field. For this purpose, it has advanced medical equipment: magnetic resonance imaging (MRI), multispiral computed tomography (CT), duplex sonography and digital X-ray, fluoroscopy, etc. In the field of interventional radiology, the focus is on the treatment of vascular diseases, for example, the doctors of the department conduct special measures for dilating the vessels in peripheral arterial occlusive disease and closing the vessels in complicated bleedings. Also, the range of services in this field is complemented by the installation of drainage and port systems, punctures, and special percutaneous methods for tumor treatment.
Department of Adult and Pediatric Diagnostic, Interventional Radiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology offers the full range of services in these medical fields. It conducts all modern radiological examinations and imaging-guided minimally invasive interventions for the treatment of various benign and malignant diseases. A feature of the department is imaging diagnostics in children and adolescents. There are specially adapted devices with minimal irradiation for this purpose.
Department of Interventional Radiology
The Department of Interventional Radiology provides the full range of medical services in the area of its specialization. The team of the department's doctors specializes in diagnostic and therapeutic image-guided interventional procedures. The doctors have at their disposal the most advanced imaging devices, including X-ray systems, ultrasound devices, equipment for computed tomography and magnetic resonance imaging. In most cases, the department's specialists perform interventions on the vessels, and therefore doctors from the Department of Vascular Surgery are often involved in the therapeutic process. The use of state-of-the-art equipment allows the patients to get rid of pathological changes in the vessels of any part of the body, excluding open invasive surgery with its high risks. The department's medical staff has excellent qualifications and vast clinical experience, so patients confidently trust their health to real professionals.
Liver cancer is not the most common malignant tumor, but it is very aggressive. This type of cancer has an unfavorable prognosis, therefore, in terms of mortality from cancer causes, liver cancer ranks fourth in the world. Few patients are candidates for surgical treatment. If it is not possible, then hepatic artery chemoembolization becomes the main method of fighting the tumor.
Content
- What are embolization and chemoembolization
- How long has chemoembolization been used
- How is the treatment provided
- After the procedure
- Benefits of chemoembolization
- Repeated chemoembolization
- Why is it worth undergoing embolization abroad
- Treatment in Europe with Booking Health at an affordable price
What are embolization and chemoembolization
Embolization is the closure of the lumen of an artery.
The tumor grows very quickly. It needs a lot of blood to grow in size and metastasize. Therefore, the neoplasm becomes overgrown with arteries, consuming a large amount of nutrients and oxygen.
The essence of the therapeutic method is to impair the blood supply to the tumor. To do this, emboli are injected into the lumen of the blood vessels. These are substances that clog the lumen of the arteries. The tumor does not receive blood and dies off quickly.
Embolization has been used since the middle of the twentieth century. But today this procedure is carried out in a different way. Embolization can very rarely be used in isolation. Basically, doctors use chemoembolization, which is a combination of embolization and regional chemotherapy.
The essence of this method is that high concentrations of chemotherapy drugs are injected into the vessels feeding the tumor. Such quantities cannot be used systemically (intravenously) due to significant harm to the patient's health. However, topical application is safer. Doctors can multiply the dosage without increasing systemic toxicity.
In modern medicine, chemoembolization with microspheres is most often used. The microspheres are saturated with chemotherapy drugs. They are released several days or even several weeks after embolization, thereby damaging cancer cells.
Another option is oil chemoembolization. Unlike microspheres, the vessels do not close forever, but for a while. This makes it possible to carry out the procedure multiple times.
How long has chemoembolization been used
Hepatic artery chemoembolization has been used in medicine since the 1970s. Regensberg was one of the first to describe it. He published the results of 250 patients. For vascular embolization, the specialist used a suspension of Karyolysin, a hemostatic sponge and Thrombovar.
Japanese scientists headed by R. Yamada are considered to be the official authors of the method. In 1979, experts used a gelatin sponge saturated with chemotherapy drugs. It was injected under X-ray control into the hepatic artery in patients with unresectable liver cancer.
In 1982, lipiodol, a drug for oil chemoembolization, was used for the first time. This drug has two unique properties: it accumulates the chemotherapy drug and remains inside the tumor for a long time.
In the 21st century, drug-saturated microspheres appeared. They absorb the drug and release it through the ion exchange mechanism. As a result, the doctors were able to ensure not a short-term, but a long-term effect of chemotherapy on liver carcinoma cells. With the help of microspheres, it is possible to achieve a more pronounced effect. In addition, the method is less toxic than oil chemoembolization.
How is the treatment provided
A catheter is used to deliver emboli and chemotherapy drugs. It is injected through the vessels in the leg or arm.
The treatment is minimally invasive. It is performed under X-ray guidance. The doctor makes an incision and delivers the catheter to the hepatic artery. He then injects a contrast agent and uses an x-ray to check where the liver cancer is getting its blood supply. After that, the doctor injects emboli into the lumen of these vessels. He uses microspheres of different diameters to block the arteries feeding the tumor.
Transarterial chemoembolization has been used in medicine for decades. It is especially often used in countries with a developed healthcare system. The technique combines good efficiency and safety indicators.
Although the doctor clogs the blood vessels of the liver, minimal damage is caused to the parenchyma. This is due to the peculiarities of the blood supply to the tumor. It receives 90% of its blood from the hepatic artery system. At the same time, 80% of the blood supply to a healthy liver comes from the portal vein system. Although the blood flow in it decreases as a result of the procedure, the damage to the tumor is much greater than to the healthy parenchyma. In most patients, liver function is not significantly reduced.
In countries with developed healthcare systems, superselective chemoembolization is performed. This means that doctors block the smallest possible arteries located directly near the tumor. With this approach, the procedure becomes even safer.
After the procedure
Postembolization syndrome develops after the procedure. It is associated with the death of tissues that are disconnected from the blood supply. This syndrome is usually not dangerous. Its manifestations can be eliminated by drugs. Symptoms disappear within 2-3 days.
Postembolization syndrome may have the following manifestations:
- Right upper quadrant pain.
- Nausea.
- Vomiting.
- Temporary worsening of liver failure.
The risk of complications is low – about 10%, and in the best European hospitals this indicator is about 4%. There are three groups of complications: those associated with the blockage of non-target vessels, with the action of chemotherapy drugs or a contrast agent, as well as complications in the area of the vessel puncture. Most complications are not severe.
Benefits of chemoembolization
The best results in the treatment of liver cancer can be achieved with the surgical method. Only complete removal of the tumor can help cure the disease. But in 80% of cases, at the time of diagnosis, the patient is not considered a candidate for surgical treatment: due to the advanced stage of cancer or reduced liver function. In such situations, embolization of the tumor becomes the main treatment method. Doctors clog the arteries that feed the neoplasm, causing the carcinoma to shrink in size.
In 2018, the European Society for Medical Oncology (ESMO) issued new guidelines for hepatic artery chemoembolization. This method is now recommended as a standard method even in the earliest stages of liver cancer (BCLC 0 and (BCLC A). Previously, it was used only in the intermediate stage (BCLC B).
The main purpose of embolization and chemoembolization is local control of the tumor. In fact, this treatment is palliative, not radical. Nonetheless, it provides the best possible patient survival rates. After the procedure, life expectancy increases by several years. Chemoembolization can be performed repeatedly.
The advantages of the method:
- A dual mechanism of action: doctors use chemoembolization to simultaneously block off the arteries feeding the tumor and deliver large doses of chemotherapy drugs to the liver.
- Embolization is safe for health when compared to surgery.
- No significant trauma: manipulations are performed through the vessels, but not through a large incision in the abdomen.
- There is no need for a long hospital stay.
- Since the treatment procedure is minimally invasive, long-term rehabilitation is not required after it.
- Good tolerance of the procedure: after it, postembolization syndrome develops, but its manifestations gradually regress and completely disappear after 2-3 days.
- The best survival rates of any treatment except surgery.
- Possibility of multiple use of embolization.
- The procedure can be successfully used even with large neoplasms, when it is impossible to perform ablation of tumor foci.
- Compatibility of embolization with any other treatment for liver cancer.
Chemoembolization performed for the first time is almost always effective. The complete response rate (disappearance of tumor foci) is about 70%. In another 30% of cases, a partial response is achieved: the neoplasm in the liver can be reduced by at least 30%.
Repeated chemoembolization
Some patients undergo several chemoembolization procedures throughout their lives.
The first procedure is usually the most successful. Tumor foci can decrease several times. The disease does not progress long enough: several months or even several years. But at a certain point, the growth of the tumor may resume. In this case, doctors perform repeated chemoembolization.
There are no restrictions on the number of hepatic artery embolizations performed. It can be performed as long as the patient responds to therapy and as long as there is no major damage to health.
If chemoembolization no longer works, doctors resort to systemic therapy. The criterion for making such a decision is considered to be 2 unsuccessful embolization procedures, after which medical specialist reveal:
- Tumor growth.
- Increase in the number of tumor foci.
- Increase in tumor markers of the neoplasm after the procedure.
- Development of vascular invasion.
- Development of extrahepatic metastases.
The best results from repeated chemoembolization procedures can be achieved in the patients with isolated intrahepatic progression of the disease, with preserved liver function.
Why is it worth undergoing embolization abroad
Many patients choose to travel to countries with advanced healthcare systems to undergo cancer treatment. In many states with a poor level of medicine, chemoembolization is not carried out at all or is not performed effectively enough, according to outdated methods.
You can undergo treatment in Europe. There are several reasons why it is worth going to one of the countries with a high level of healthcare system:
- The use of modern methods of chemoembolization with saturated microspheres.
- Performance of superselective embolization – emboli are injected into the minimum caliber arteries located as close to the tumor as possible to minimize the risk of side effects.
- If possible, the catheter is inserted through the radial rather than the femoral artery in order to reduce the risk of complications in the puncture site and to relieve the patient of the need to comply with strict bed rest on the first day after the procedure.
- The possibility of embolization even with atypical location of the blood vessels feeding the liver.
- High-precision diagnostics allow perfect treatment planning.
- Chemoembolization procedures abroad can be successfully combined with other methods: ablation, radiation therapy, systemic drug treatment.
Treatment in Europe with Booking Health at an affordable price
To undergo treatment in one of the European hospitals, please use the services of the Booking Health company. On our website, you can find out the cost of treatment in different hospitals, compare prices and book a medical care program in one of the countries with developed healthcare systems. Transarterial embolization in European hospitals will be easier and faster for you, while the cost of treatment will be lower.
Please leave your request on our website. Our employee will contact you and advise you about the treatment in Europe. Booking Health will take care of the organization of your trip. We will provide the following benefits for you:
- We will choose a hospital for treatment in Europe, whose doctors specialize in the treatment of liver cancer and achieve the best results.
- We will help you overcome the language barrier, establish communication with your attending physician.
- We will reduce the waiting time for the start of the medical care program and book a doctor's appointment on the most suitable dates.
- We will reduce the price. The cost of treatment in German hospitals will be lower due to the lack of additional coefficients for foreign patients.
- We will take care of all organizational issues: documents for entering the country, transfer from the airport, hotel, interpreter, etc.
- We will prepare a program and translate medical documents. You do not have to repeat the previously performed diagnostic procedures.
- We will provide communication with the hospital after treatment in Europe.
- We will organize additional diagnostic examinations and treatment in European hospitals, if necessary.
- We will buy medicines abroad and forward them to your native country.
- We will help you keep in touch with the hospital and the doctor after treatment in Europe.
You will receive treatment from the best doctors in the world. The Booking Health staff will help reduce the cost of treatment and take care of all organizational issues, and you will only have to focus on restoring your health.
Authors:
The article was reviewed by an expert in the field of medicine Prof. Dr. med. Thomas Vogl
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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