Rectal 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 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.
Rectal cancer is a tumor of the distal (lower) part of the intestine. It is a more severe disease compared to tumors of other parts of the large intestine. However, the disease is successfully treated abroad with surgery, radiation therapy, and drug therapy. In cases of rectal cancer recurrence or contraindications to standard treatment, chemoembolization may be used. It is a minimally invasive endovascular procedure during which the malignant tumor is deprived of blood supply by closing the lumen of the blood vessels.
Content
- How is rectal cancer treated?
- What are embolization and chemoembolization?
- When can chemoembolization be used for rectal cancer?
- Where can I undergo treatment?
How is rectal cancer treated?
Surgery is the best treatment option and the only method that gives a chance for a complete cure of the pathology. For rectal cancer treatment in Germany, doctors may perform endoscopic resection, surgical transanal excision, laparoscopic resection, or Da Vinci treatment (robot-assisted surgery).
Whenever possible, anastomosis is applied immediately after tumor removal to restore bowel continuity with the possibility of independent defecation. However, complications during initial treatment often necessitate the use of a colostomy (an opening in the abdomen for fecal diversion). After a few months, a second operation for colostomy closure is performed.
For advanced cancers that have spread throughout the peritoneum, cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) may be used.
At the same time, up to 20% of cases of rectal cancer are detected at an inoperable stage. Moreover, many patients have cancer recurrence after surgery, radiation therapy, and chemotherapy. Only a few of them are considered candidates for revision surgical treatment. Doctors usually use only palliative procedures (endoscopic dilation in stenosis) and systemic therapy (chemotherapy, personalized targeted therapy, and immunotherapy).
Doctors in developed countries also use embolization and chemoembolization. These are effective methods of local tumor control. These procedures are used in patients for whom surgery and radiation therapy are contraindicated.
What are embolization and chemoembolization?
Embolization is a minimally invasive procedure to close the lumen of the arteries that supply blood to the tumor. It is performed to shrink the size of the tumor and eliminate rectal bleeding. The mechanism of antitumor effects is based on depriving the tumor of blood supply because cancer cells die from lack of oxygen.
Regional chemotherapy may enhance the effect of embolization. In such a variant, this procedure is called chemoembolization.
The treatment is performed using a minimally invasive method. Under local anesthesia, doctors make an incision in the groin, insert a catheter, and guide it to the tumor blood vessels. They use a contrast agent to see which arteries are supplying blood to the tumor. These blood vessels are closed with emboli. The blood flow is then checked again. If all the arteries are closed properly, the procedure is complete. If there is still blood flow, the embolization is repeated with larger particles.
Chemoembolization is performed using different methods. This may involve the separate administration of embolisate and chemotherapy drugs, but drugs may also be contained in drug-saturated microspheres.
Conventional transarterial chemoembolization is abbreviated as TACE. Doctors also use various embolization options involving microspheres, tiny balls saturated with chemotherapy drugs. Some of them subsequently dissolve, while others remain in the blood vessels permanently, causing irreversible embolization. Some microspheres are initially saturated with drugs, while others are saturated at the hospital just before the procedure. Depending on the type of microspheres used and the drugs they contain, the TACE procedure may have different names. For example:
- DSM-TACE (degradable starch microspheres)
- DEBIRI-TACE (irinotecan-saturated microspheres, a common chemotherapy drug for treating bowel cancer)
- DEB-TACE (doxorubicin-saturated microspheres)
Some studies show that the use of microspheres is a more effective treatment method for colorectal cancer than conventional chemoembolization, increasing the objective response and survival rates of patients. In addition, the use of microspheres improves the tolerability of the procedure and the rehabilitation period compared to classical chemoembolization.
When can chemoembolization be used for rectal cancer?
In cases of rectal cancer, embolization can be used for:
- Rectal blood vessels
- Liver blood vessels, where metastases of rectal cancer often occur
Chemoembolization is more often performed as part of metastasis-directed therapy. The procedure to close the branches of the hepatic artery has been used in medicine for ten years. It is very successful due to the peculiarities of the blood supply to the liver, as healthy tissue receives nutrition from the portal vein and metastases from the hepatic artery.
Liver metastases may appear synchronously with the primary tumor and be detected during the primary diagnosis. In such cases, chemoembolization can be combined with surgical treatment when the rectal tumor is removed and liver metastases are controlled through an endovascular procedure.
Liver metastases may also be detected later, as a rectal cancer recurrence, after the removal of a fragment of the rectum. In such cases, chemoembolization can be used as the main or only treatment method, especially in conditions where liver resection is impossible or contraindicated.
Rectal arterial chemoembolization is less common. It is mainly used to stop bleeding. Less commonly, rectal cancer chemoembolization in Germany is performed for tumor control, but it is not yet considered a standard procedure, so it is used as part of clinical trials. Some of these trials show promising results.
One of the studies showed that chemoembolization with microspheres for inoperable patients or patients with recurrent rectal cancer resulted in at least stabilization of the disease and an arrest of tumor growth. In a third of cases, the size of the tumor shrinks to the point where it becomes resectable (can be removed surgically). Although there was no control group in this study, according to the literature, the median survival rate of such severe patients is 6 months. Therefore, the authors considered the treatment results to be outstanding.
In addition to affecting tumor size and survival rate, the chemoembolization also improves quality of life. It alleviates pain, reduces hemorrhage, and decreases the risk of bowel obstruction and defecation disorders. Patients are less likely to suffer from anemia and lose less weight. General symptoms such as weakness, nausea, depression, anxiety, drowsiness, poor appetite, malaise, and shortness of breath are also alleviated.
Where can I undergo treatment?
You can undergo your diagnostics and treatment in Germany. Advanced German clinics successfully perform chemoembolization of both hepatic and rectal arteries.
You can make your treatment appointment on the Booking Health website. This is a convenient service for selecting clinics. On our website, you can find the leading medical centers specializing in chemoembolization for rectal cancer and the current prices. The cost of CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) for rectal cancer is between 52,120 EUR and 91,970 EUR.
When using the Booking Health service, your treatment costs will be lower due to the absence of additional fees for foreign patients. Our company's specialists will help you select the most suitable hospital 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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