Liver Cancer — Embolization or Chemoembolization: treatment in the Best Hospitals of Germany
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 an aggressive and frequently occurring oncology. More than 900,000 new cases are registered in the world every year, making it the fifth most common form of cancer. In most cases, the tumor is detected at an unresectable stage. In such cases, a minimally invasive endovascular procedure called chemoembolization can increase the survival rate of patients.
Content
- What is chemoembolization?
- When can chemoembolization be used?
- How does chemoembolization work for liver cancer treatment?
- What is the process of treatment?
- Treatment effectiveness
- Where can I undergo treatment?
What is chemoembolization?
Systemic chemotherapy has low effectiveness for liver cancer because these tumors have multiple drug resistances.
A much more effective procedure is regional chemotherapy, in which drugs are delivered directly into the artery supplying the tumor. One form of regional chemotherapy is chemoembolization. This is a procedure that blocks arteries with emboli containing chemotherapy drugs.
This method has the following advantages:
- Dual mechanism of action: embolization (depriving the tumor of blood supply) combined with regional chemotherapy
- The concentration of chemotherapy drugs in the tumor is much higher compared to systemic therapy
- Low systemic toxicity of treatment
- Minimal trauma rates
Research has proven the effectiveness of percutaneous embolization, so chemoembolization has long ceased to be an experimental procedure. It is a standard treatment option that most medical societies have approved and recommended.
When can chemoembolization be used?
Radical surgery is considered the best option for treating liver cancer. Depending on the size and location of the tumor, this can be a unilateral hepatectomy, wedge liver resection, atypical marginal resection, or extensive liver resection.
Unfortunately, only a few patients are candidates for radical (potentially curable) surgical treatment. Liver cancer is more often diagnosed in its advanced stages. In addition, this disease mainly develops due to viral hepatitis and cirrhosis, which makes it impossible to remove a significant part of the organ due to low functional reserve.
Most patients with primary liver cancer are therefore not candidates for surgical treatment, even when diagnosed for the first time. Moreover, the tumor may recur after surgery in some patients, and repeated surgical treatment is usually not performed.
Therefore, tumor node ablation (destruction by radiofrequency or microwave energy) and chemoembolization have become the main treatment methods for most patients. These two procedures may be combined because multiple tumor nodules are often located in the liver.
Optimal candidates for chemoembolization are patients with unresectable tumors that are well supplied with blood (based on angiography findings) and inaccessible to ablation. The reason for refusing ablation may be the proximity to large blood vessels and bile ducts, as well as the large size of the tumors.
Chemoembolization is used to increase the patient's life expectancy. It is also used as a "bridge to transplant surgery", during the waiting period for a donor organ.
How does chemoembolization work for liver cancer treatment?
The liver has a dual blood supply. Most of the normal parenchyma receives its nutrition from the portal vein system. At the same time, the tumor is supplied with blood primarily from the hepatic artery. This type of blood supply creates ideal conditions for embolization. Doctors can occlude the blood vessels supplying the tumor and destroy the neoplasm without any significant damage to the liver parenchyma.
Chemoembolization works through the following several mechanisms:
- Ischemic necrosis is the death of tumor tissue deprived of blood supply
- Regional chemotherapy is the damage to cancer cells caused by high doses of chemotherapy drugs
- Immune stimulation occurs after tumor decay when a large number of tumor antigens are released into the bloodstream, which contributes to the formation of an antitumor immune response
What is the process of treatment?
Treatment with embolization or chemoembolization is minimally traumatic. It does not require a long hospital stay or rehabilitation. The procedure is performed without general anesthesia. The standard method of anesthesia is local anesthesia in combination with intravenous sedation.
Chemoembolization is performed in the Department of Interventional Radiology. Under X-ray guidance, doctors use a 1 mm microcatheter to reach the arteries supplying the liver and inject a contrast agent to approach the blood supply of the tumor. Subsequently, the blood vessels supplying the tumor are blocked with emboli. Drug-saturated microspheres of various diameters are mainly used in developed countries. These have a number of benefits over the hepatic oily chemoembolization used in the 20th century. These are the following:
- Reliable and irreversible obstruction of the arteries supplying the tumor
- Prolonged and uniform release of cytostatics that destroy cancer cells
- More expressed cytoreductive response (tumor shrinks more)
- Fewer side effects and better tolerability of the procedure
- Shorter hospitalization time
Doxorubicin is mainly used as a drug to destroy cancer cells, and less commonly, this may be anthracycline. There are many other drugs, for example, irinotecan, which can be included in the composition of microspheres, but they are mainly used for liver metastases from cancer of other localizations, most commonly colorectal cancer.
To prevent emboli from entering non-target blood vessels, coiling spirals are sometimes used to protect them. This allows doctors to reduce the risk of blockage of arteries in other organs.
Upon the completion of the procedure, a follow-up angiography is performed to check if the procedure was successful. If there is still blood flow in the tumor, doctors may use additional embolization particles to finally close the blood vessels.
Treatment effectiveness
Chemoembolization cannot cure liver cancer, but it can increase the duration and quality of life and reduce the risk of complications.
The effectiveness of the procedure for primary liver cancer was proven by two large trials in 2002, and since then it has become a standard procedure in most developed countries.
One of the recent studies showed that the use of microspheres with doxorubicin resulted in a one-year survival rate in 77.2% and a two-year survival rate in 64.6% of cases. Moreover, the additional use of sorafenib after the chemoembolization procedure improved these rates. They were 96.2% and 82.7%, respectively.
Other studies have also demonstrated the benefits of chemoembolization and ablation compared to chemoembolization alone. Therefore, liver cancer treatment in Germany is often performed using both procedures.
Where can I undergo treatment?
You can undergo your treatment in Germany. There are a few reasons for you to use the services of doctors at German clinics. These are as follows:
- Accurate liver cancer diagnostics
- Personalized medicine
- Superselective chemoembolization with minimal risks of damage to healthy liver parenchyma and bile ducts
- Protection of non-target blood vessels with coils to reduce the risk of complications
- Successful combination of the procedure with ablation, irradiation, or systemic therapy
You are welcome to use the Booking Health service to make an appointment for your diagnostics and liver cancer chemoembolization in Germany. On our website, you can find the best hospitals for liver cancer treatment and current prices. When you make your treatment appointment through Booking Health, you save money because the cost of services will be lower due to the absence of additional fees for foreign patients. The Booking Health specialists will help you select the most suitable hospital and arrange your trip to Germany.
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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