Thyroid Cancer — Embolization or Chemoembolization: treatment in the Best Hospitals in the World
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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.
Thyroid cancer is a very common and usually non-aggressive tumor. However, in some patients, it is detected too late. There are also aggressive types of carcinoma: medullary, anaplastic cancer. In such situations, the treatment of the disease involves the use of not only standard, but also innovative methods. Doctors abroad opt for superselective chemoembolization of the thyroid arteries. The procedure is effective even for advanced and aggressive cancers, including those with distant metastases.
Content
- What is embolization
- In what cases can thyroid arterial embolization be used
- How is thyroid arterial embolization performed
- Embolization before surgery
- Chemoembolization for local control of cancer
- Embolization as palliative care
- Hepatic artery embolization
- Why is it worth undergo thyroid carcinoma treatment abroad
- Treatment in Europe with Booking Health at an affordable price
What is embolization
Embolization is a cancer therapy option that involves closing the lumen of the vessels feeding the tumor. Cancer cells do not receive blood, so they die quickly.
In patients with thyroid carcinoma, embolization can be used for a variety of purposes. If the method is used as a palliative or preoperative treatment option, it is usually carried out in its pure form. If the procedure is carried out as an independent method of controlling cancer, then the closure of the lumen of the arteries is complemented by regional cytostatic therapy, which involves the introduction of chemotherapy drugs into the lumen of the arteries. They are usually included in emboli.
Chemoembolization is more effective because it acts on carcinoma through two mechanisms: it disrupts the blood flow in the tumor and suppresses cancer cells with high doses of cytostatics.
In what cases can thyroid arterial embolization be used
The main treatment for patients with thyroid carcinoma is surgery. The second most important method is radionuclide therapy (radioiodine therapy).
Embolization and chemoembolization can rarely be used for this disease. Only a few European hospitals can carry out this procedure. It is usually used in patients who are not subject to either surgery or radioiodine therapy.
More often, chemoembolization can be used for aggressive forms of thyroid carcinoma, namely medullary and anaplastic. These types of cancer cannot be treated with radioactive iodine because tumors do not absorb it from the blood. Less commonly, embolization can be performed in patients with differentiated forms of thyroid cancer: papillary, follicular. The procedure is performed at an advanced stage, in case of patient refusal or medical contraindications to surgery and radioiodine therapy.
In some patients, the tumor is located behind the sternum. In this case, the operation to remove the neoplasm becomes traumatic, since a sternotomy is required. This procedure involves a large incision in the center of the sternum with opening the chest. In patients with a high surgical risk, such surgical operations are avoided. An elderly person who is weakened by cancer or underlying medical conditions may not tolerate such a surgical intervention. Therefore, in such patients, alternative treatment options are used, including chemoembolization.
Sometimes endovascular treatment can be combined with surgery. In this case, after closing the lumen of the arteries, surgical intervention is performed within 1-2 days.
In case of thyroid carcinoma with metastases in the liver, hepatic artery chemoembolization is used. Liver metastases most often develop with medullary carcinoma.
Thus, embolization for thyroid cancer can be performed:
- Instead of a surgical intervention.
- Immediately prior to a surgical intervention.
- To combat distant metastases.
The goal of treatment may be not only to control cancer, but also to prepare for surgery, and in an advanced stage, to relieve symptoms.
How is thyroid arterial embolization performed
To combat the primary tumor, embolization or chemoembolization of the upper and lower thyroid arteries is performed. This is a minimally invasive procedure. It is performed through a small incision in the groin or arm.
Transfemoral access is used more often. The doctor makes a small incision in the groin to insert a catheter into the femoral artery. It then reaches the arteries of the thyroid gland. The doctor uses a contrast agent to assess the characteristics of blood flow in the tumor and organs in the neck. It is important to inject emboli only into the target vessels so as not to cause ischemic necrosis of healthy tissues and organs. After the contrast is injected, a series of X-rays are taken.
Then the embolization itself is carried out directly. Doctors inject microspheres into the upper and lower thyroid arteries. If chemoembolization is used, the microspheres are saturated with chemotherapy drugs. This variant of the procedure is preferred for patients in whom endovascular treatment is the main one and is used for local control of cancer.
Embolization before surgery
The main treatment for thyroid cancer is thyroidectomy. In some hospitals, embolization is performed as a preoperative procedure. The surgical intervention itself is usually performed the day after the endovascular procedure.
Embolization is performed without a combination with regional chemotherapy. It is performed in order to:
- Reduce blood loss during surgery.
- Reduce the time of the operation.
- Reduce the release of thyroid hormones into the blood.
After embolization, the thyroid gland is exsanguinated. During its removal, blood loss is insignificant. The postoperative period is easier. There are no systemic complications associated with the effects of thyroid hormones on the body. It is assumed that embolization contributes to the reduced risk of cancer recurrence.
Chemoembolization for local control of cancer
At any stage, even at the fourth stage of thyroid cancer, patients are offered surgery, since this method of treatment provides the best survival rates. However, the tumor can sometimes be located behind the sternum, the patient has medical contraindications for surgery or refuses to undergo a surgical intervention.
The second most effective method of treatment is radioiodine therapy. Nonetheless, this kind of therapy is also unsafe, and some patients refuse the procedure. In addition, not all types of thyroid cancer are capable of absorbing iodine. For medullary and anaplastic cancer, radioiodine therapy cannot be used.
In such situations, doctors resort to alternative methods of local control of the tumor. One of the best options is thyroid arterial chemoembolization. Doctors close arteries with drug-eluting microspheres containing chemotherapy drugs. As a result, the tumor is damaged due to two mechanisms: the cessation of blood flow and the destruction of cancer cells by cytostatics, which are released from the microspheres within several weeks.
After the procedure, the neoplasm decreases in size. In combination with complementary therapies, chemoembolization significantly increases the duration and quality of life of patients, even with advanced and aggressive types of cancer. Chemoembolization can be repeated. If the disease progresses, then the procedure will be repeated after a few months.
Embolization as palliative care
In the advanced stages of cancer, for patients who are not suitable for surgery embolization is used as a palliative procedure. Patients with thyroid carcinoma may suffer from pain and bleeding. With anaplastic cancer, suffocation often occurs due to the compression of the airways.
Embolization of the upper or lower thyroid arteries can help relieve these symptoms. The size of the neoplasm decreases, bleeding stops in patients, pain syndrome decreases, and swallowing function improves.
Some types of cancer produce not only local but also general symptoms. These tumors produce thyroid hormones and can therefore cause uncontrolled thyrotoxicosis. Arterial embolization helps destroy functioning cells and reduce hormone production.
If an endovascular procedure is performed as part of palliative care, it is usually not combined with regional chemotherapy. The thyroid arteries are closed with solid particles, glue, spirals or microspheres that do not contain cytostatics. The effect is provided only by ischemia (insufficient blood supply) of the organ.
Hepatic artery embolization
Thyroid cancer with liver metastases requires removal or control of not only the primary tumor, but also metastatic foci. The priority is always given to surgical interventions. Nonetheless, only a few patients are considered candidates for combined surgical interventions for the simultaneous removal of the tumor and metastases. Therefore, more often distant foci of metastasis are destroyed with the help of chemoembolization.
Liver metastases occur in 45% of patients with medullary thyroid cancer. In such cases, the main treatment is systemic chemotherapy, but it is not always capable of providing high patient survival rates. The best results can be obtained by complementing systemic therapy with the methods of local control of metastatic tumors.
Chemoembolization is the most common method for suppressing liver metastases. Doctors inject microspheres into the branches of the hepatic artery that feed the metastases. Total hepatic artery embolization can also be performed.
The liver has a dual source of blood supply. It receives 75% of its blood from the portal vein and 25% from the hepatic artery, but thyroid cancer metastases feed on arterial blood for 90%. Therefore, the closure of the lumen of the hepatic artery leads to the rapid death of cancer cells, while most of the healthy parenchyma is not damaged.
Chemoembolization is less effective than surgery, but safer. Therefore, it is the method used in most patients. There are not many contraindications for the procedure. It is not performed unless the tumor has affected more than half of the liver or the patient has developed liver failure. For the rest, the procedure is safe, well tolerated, and provides excellent results.
After hepatic artery chemoembolization, the patient experiences diarrhea, flushing, and abdominal pain. The size of the tumor reduces by several times.
The procedure is almost always effective. In about half of patients, a partial response is observed – a decrease in tumor foci by more than 30%. Another half of the patients have stabilization of the oncological process: tumors stop growing or shrink, but by less than 30%. The best response is obtained in patients in whom less than 30% of the liver is affected, and the size of metastases does not exceed 3 cm.
For thyroid cancer, the procedure is very successful. The average time to disease progression since the last chemoembolization is 3 years. Even if the tumor begins to grow again, the treatment procedure can be repeated. The results of repeated procedures are slightly worse: the response to treatment is achieved less often, and the duration of the progression-free period is shortened.
Almost all patients treated with chemoembolization also undergo surgical treatment. The primary tumor in the thyroid gland is removed. Many have bone metastases, which are usually treated with radiation therapy.
Why is it worth undergo thyroid carcinoma treatment abroad
Chemoembolization of the arteries in thyroid carcinoma is not considered a standard treatment for this disease. Only a few hospitals, mainly in countries with developed medicine, have experience in carrying out this procedure.
It is safer and more effective to undergo carcinoma treatment abroad. Doctors in Europe use innovative methods. They successfully combine surgery, radionuclide methods, and drug therapy. European specialists use endovascular methods both to suppress the carcinoma itself and its metastases.
There are several reasons why it is better to undergo thyroid carcinoma treatment in countries with developed medicine:
- Few hospitals use embolization for this disease. This procedure may not be carried out in your native country at all.
- Highly accurate diagnostics allow for a perfect assessment of the blood supply to the carcinoma prior to the procedure.
- Doctors perform superselective chemoembolization – they close the lumen of the arteries located as close to the tumor as possible so as not to disrupt the blood supply to other organs of the neck.
- The use of modern methods of embolization, including drug-eluting microspheres.
- Chemoembolization is performed to destroy the carcinoma and its metastases in the liver.
- The procedure can be successfully combined with other methods of treating thyroid carcinoma: radionuclide therapy, surgery, systemic drug therapy.
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 see the cost of treatment in different hospitals, compare prices and book a medical care program at a favorable price. The cost of embolization or chemoembolization for thyroid cancer is between 24,620 EUR and 41,270 EUR. Transarterial embolization in European hospitals will be easier and faster for you, and the cost of treatment will be lower.
Please leave your request on our website. Our employee will contact you and advise you about 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 thyroid cancer treatment.
- 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 European 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, interpreting services, 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 be treated by the best doctors in the world. The Booking Health employees will help reduce the cost of treatment and solve all organizational issues, and you will only have to focus on restoring your health.
Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko