Mar. 26, 1999 Chemotherapy Delivered Directly to Liver Tumors Doubles Life Expectancy
(Philadelphia, PA) -- More than 150,000 new cases of colon cancer are diagnosed each year, and, for half of these patients, the disease spreads to the liver. A Phase-II study performed by a team of researchers at the University of Pennsylvania Medical Center has found that a minimally invasive technique known as chemoembolization may double the survival time of adult patients with colon cancer that has spread to the liver. Michael C. Soulen, MD, associate professor of radiology at Penn and senior author of the study, will present these findings at the 24th Annual Scientific Meeting of the Society of Cardiovascular & Interventional Radiology (SCVIR) on Wednesday, March 24, in Orlando, Florida.
Systemic chemotherapy delivers cancer-killing medication into the bloodstream where it travels throughout the body and eventually reaches the tumor. In contrast, chemoembolization works by delivering chemotherapy directly to cancerous cells with the use of a non-surgical, interventional catheterization technique. This technique also involves the infusion of tiny particles that cut off the blood supply to the tumor, thus inhibiting cancer-cell growth. Colon cancer that has metastasized, or spread, can be managed with chemoembolization when systemic chemotherapy has failed. "Chemoembolization hones in on the cancerous cells that have spread to the liver and avoids exposing the rest of the body to chemotherapy's toxic effects," explains Dr. Soulen. "This technique is not a cure, but it can extend patients' lives and preserve their quality of life."
In this study, 51 patients whose colon cancer had metastasized to the liver were treated with chemoembolization. Eighty-six percent (86%), or 44 of the patients, survived one year after treatment. The patients in this study survived an average of two years. Typically, less than half of liver cancer patients survive one year after undergoing systemic chemotherapy.
Chemoembolization is performed while the patient is under conscious sedation, and is administered by an interventional radiologist. The procedure involves making a small needle puncture in the patient's groin and inserting a catheter, or tiny tube, into the liver's hepatic artery. Using a moving X-Ray, the arteries to the liver are identified and three chemotherapy drugs are delivered directly to the hepatic artery leading to the tumor -- thus sparing healthier liver tissue. The hepatic artery is then blocked off, or embolized, with a mixture of oil and tiny particles. This technique deprives the tumor of fortifying oxygen and nutrients, while saturating the tumor with high doses of medication. Chemoembolization is effective without damaging the liver because the hepatic artery is central to the tumor's survival, however it provides only twenty-five percent (25%) of the liver's blood supply. The liver is unique in that it has two blood supplies -- a hepatic artery as well as a large portal vein that furnishes ample blood flow on its own.
The chemoembolization procedure is approximately three hours in length, and involves an overnight hospital stay. It is performed repeatedly on a monthly basis, with an average treatment regimen of approximately three sessions.
"With chemoembolization we can offer a less taxing and effective treatment for liver cancer," said Dr. Soulen. "Although not curative, it can extend and preserve a more normal life for the patient by minimizing the cancer and its effects."
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