Ovarian Cancer — Embolization or Chemoembolization: treatment in the Best Hospitals of 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 Interventional Radiology and Neuroradiology
The Department of Interventional Radiology and Neuroradiology offers a full range of advanced imaging diagnostics and minimally invasive treatments on both an inpatient and outpatient basis. The department has state-of-the-art medical equipment for imaging tests such as X-ray, computed tomography, magnetic resonance imaging, digital subtraction angiography, and mammography. The medical facility also performs many highly effective interventional therapeutic procedures under image guidance, which in many cases allow patients to avoid traumatic open surgery. For example, the department successfully performs local fibrinolysis, thrombectomy, percutaneous transluminal angioplasty, hemostasis, transarterial chemoembolization, uterine artery embolization, and other procedures. The department's neuroradiologists specialize in brain and spinal cord imaging and the treatment of central nervous system disorders. Interventional neuroradiology focuses on the treatment of carotid artery stenosis, brain aneurysms, arteriovenous malformations, dural fistulas, subdural hematomas, brain tumors, skull base and spinal tumors, and chronic back pain. The department's medical team has extensive clinical experience in their areas of expertise. The specialists are guided by the recommendations of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Society for Neuroradiology (DGNR), which helps to achieve the best results.
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 Radiology
The Department of Interventional Radiology specializes in the full range of minimally invasive image-guided interventions for diagnostic and therapeutic purposes. Diagnostic interventional procedures allow obtaining tissue samples for further laboratory tests. Most minimally invasive interventional procedures are performed for the treatment of vascular obstruction or stenosis, as well as for tumor destruction. The surgeon inserts special catheters and/or probes through small skin punctures. All surgical procedures are performed under image guidance – X-ray, digital subtraction angiography, ultrasound, CT, MRI. The specialist can clearly see all the anatomical structures and a pathological focus, thanks to which he accurately controls the delivery of the catheter to the required site and all subsequent manipulations. It is worth noting that the department was awarded the quality certificate of the German Society for Interventional Radiology (DeGIR) in 2018, which guarantees effective treatment in accordance with modern medical standards. The department's doctors have the necessary skills and qualifications, which allow them to select the best treatment option for each patient and ensure its successful conduction.
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 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 Interventional Radiology
The Department of Interventional Radiology offers a full range of modern imaging tests and image-guided therapeutic procedures. The department performs imaging examinations for patients from all departments of the University Hospital Oldenburg: X-ray, computed tomography, magnetic resonance imaging, sonography, mammography, and angiography; diagnostic examinations are performed on an outpatient basis. To ensure accurate diagnosis and effective treatment, the department has state-of-the-art medical equipment, including a 64-slice spiral CT scanner, two high-performance 1.5 Tesla MRI scanners, advanced equipment for digital subtraction angiography, pulsed fluoroscopy, and many other devices. The department's team of physicians also specializes in image-guided therapeutic interventional procedures – the treatment of vascular stenoses and occlusions, malignant tumors, and chronic back pain. Therapeutic manipulations are often performed on an outpatient basis. The department adheres strictly to radiation safety standards, so patients can expect highly effective and safe treatment.
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.
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, 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 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 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.
Ovarian cancer is the most severe and prognostically unfavorable gynecologic cancer. 25% of patients are diagnosed with the oncological disease only at the fourth stage. Moreover, 20% of them have liver metastases. The best treatment option in such cases is considered liver resection surgery, but it is a complex operation with a large number of contraindications. In addition, it is performed only in women with good control of other tumors in the body. Therefore, chemoembolization is more often used to control metastases. This is a minimally invasive procedure that has a minimum of contraindications and is well tolerated. There is no need for long-term rehabilitation after this procedure.
Content
- How is ovarian cancer treated?
- What is embolization?
- When can embolization be performed?
- How is embolization performed?
- What is radioembolization?
- Where can I undergo treatment?
How is ovarian cancer treated?
A laparoscopic salpingo-oophorectomy (removal of the ovaries and fallopian tubes) can be performed to treat early stages of cancer. Since disease screening is not carried out, ovarian cancer diagnostics usually begin when symptoms manifest themselves, so most cases are detected at the advanced stages.
The primary treatment for ovarian cancer involves cytoreductive surgery (CRS). During the intervention, the doctor performs a hysterectomy, during which he removes the uterus and its appendages and also removes all tumor foci and suspicious areas of the peritoneum detected in the abdominal cavity. The operation includes lymphadenectomy, but surgeons remove only enlarged lymph nodes, not all regional lymph nodes. Hyperthermic intraperitoneal chemotherapy (HIPEC) may be performed after surgery. Doctors rinse the abdomen with a heated solution of cytostatics to destroy accumulations of cancer cells invisible to the eye.
In cases of unresectable cancer, chemoradiotherapy, personalized therapy with immunostimulators, and targeted therapy are used. Ovarian cancer treatment in Germany often includes metastasis-directed therapy. One of the ways to combat metastasis is embolization.
What is embolization?
Embolization is the blocking of a blood vessel. For patients with cancer, this procedure is performed to deprive the tumor of its blood supply. When cancer cells are deprived of oxygen, they die quickly.
The effect of embolization can be enhanced with chemotherapy drugs. In this version, the procedure is called chemoembolization. It can be done in different ways. The most common is called oily chemoembolization. The procedure involves injecting an oil-based lipiodol solution with chemotherapy drugs into the blood vessels or embolizing with drug-saturated microspheres.
In any case, chemoembolization is a minimally invasive, sparing, and safe treatment. Most patients can tolerate the procedure, even those who are debilitated by their disease, which is especially important in the treatment of advanced cancers.
When can embolization be performed?
The main candidates for chemoembolization are patients with liver metastases that continue to grow despite systemic chemotherapy.
Thus, ovarian cancer chemoembolization in Germany is performed not to treat the primary ovarian tumor but to suppress liver metastases. They may spread even if the ovaries were previously removed during surgery. In this case, chemoembolization is performed as a stand-alone procedure. Chemoembolization can also be an addition to cytoreductive surgery for newly diagnosed ovarian cancer with liver metastases.
Chemoembolization can be used for many oncological diseases, but it is most effective for suppressing intrahepatic metastases. This is due to the fact that the liver has a dual blood supply. The portal vein and the hepatic artery supply the organ with blood. Moreover, healthy tissue receives predominantly venous blood, and pathologic tissue receives arterial blood.
Therefore, obstruction of the arteries supplying the tumor is usually highly effective and safe. It does not significantly impair liver function and, at the same time, causes catastrophic consequences for the metastatic tumor. The tumor may decrease in size by 10-20 times, and in some patients, tumor foci disappear completely.
How is embolization performed?
Transarterial chemoembolization (TACE) is a minimally invasive procedure that is performed under local anesthesia through an incision in the groin. The doctor inserts a catheter into the femoral artery. It reaches the hepatic artery under X-ray guidance. By injecting a contrast agent, doctors can see where blood flows through the blood vessels. They identify the branches of the hepatic artery that supply blood to the tumor and occlude them with emboli. As a rule, they block lobar or segmental branches.
Drug-saturated microspheres are most often used as emboli. Some of them are already produced with drugs in their composition, while others can be saturated with them in the hospital just before the procedure.
Different drugs can be used. Medicines are selected based on the type of cancer and previous experience with cancer treatment. Most often, these are mitomycin C, gemcitabine, cisplatin, or combinations of these drugs.
Following embolization, the effect develops quite quickly. Already in the first days after the procedure, the size of the tumor shrinks, and it continues to shrink for several weeks. The initial result of the procedure is achieved through ischemic necrosis: the tumor dies because no blood is supplied to its cells. Subsequently, the cancer cells continue to die as they are affected by the chemotherapy drugs gradually released from the microspheres.
This therapy is much more effective than systemic (intravenous) drug application due to the higher concentration of drugs in the focus of the lesions. At the same time, regional chemotherapy is safer. It does not cause any severe systemic side effects because most of the dose is taken up by the cancer cells, and the drugs enter the bloodstream in minimal amounts.
What is radioembolization?
Embolization can be combined with regional radiation therapy instead of chemotherapy. In this case, the microspheres are saturated with Yttrium-90. This procedure is called transarterial radioembolization (TARE), and it is less commonly used.
One of the comparative studies showed that TARE is less effective than TACE. However, it is worth considering that TARE was performed for patients with hypovascular (poor blood supply) tumors. These patients initially have worse conditions for achieving a more expressed cytoreductive (tumor shrinkage) response.
Even taking these factors into account, the difference in overall survival rates was only three months, which the authors considered insufficient to achieve statistical significance. However, the difference in objective response was more noticeable because the size of the tumor shrank more significantly under the influence of chemoembolization, and this effect lasted longer.
Where can I undergo treatment?
You can go to Germany to undergo your diagnostics and treatment for advanced ovarian cancer with liver metastases. German clinics use advanced techniques that can suppress even metastatic ovarian tumors for years.
You are welcome to use the Booking Health service to find out prices and make your treatment appointment. The cost of embolization or chemoembolization for ovarian cancer is between 24,650 EUR and 41,400 EUR. When you make an appointment through our service, the cost of medical services will be lower for you due to the absence of additional fees for foreign patients. We will help you find the best German hospitals for ovarian cancer chemoembolization and arrange your trip.
Authors:
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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