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Regional Chemotherapy

Regional Chemotherapy

Is chemotherapy limited to a local body region or body. Drugs (cytostatic or chemotherapeutic agents) are delivered via the tumor or tumor area that supplies the artery.

In regional chemotherapy, a greater amount of the cytostatic drug flows through the tumor and is absorbed into the tissue. Immediately after this therapy, the blood is washed by chemofiltration and the excess drug is removed. Thus, side effects are greatly prevented from the cancer sufferers. This observation was first made by Klopp and Biermann in the US in the early 50s.

By regional chemotherapy, it is aimed at severely damaging the tumor and minimizing the side effects of the cancer. Regional chemotherapy is effective in so-called “solid tumors”. But not all types of tumors respond equally well to highly concentrated chemotherapy. Some tumors require an extremely high concentration of the tumor-effective drug used, while some have an effect with lower concentrations.

The rule of thumb is that about six times the concentration is higher than that. given during conventional systemic chemotherapy is necessary to significantly damage a solid tumor. With various RCT techniques, the tumor can achieve three to ten times, in extreme cases, up to 80 times higher concentrations of the cytostatic agents.

Crucial to the success of regional chemotherapy is also the blood supply to the tumor. In a poorly vascularized (perfusion) tumor, only a small amount of cytostatic drug can be delivered, even via the direct arterial pathway. The circulation can be disturbed or diminished by secondary effects such as previous surgery with scarring or pre-irradiation.

The goal of regional chemotherapy is to reduce tumor size before surgery so that later surgical intervention can be kept as small as possible. At best, the tumor disappears completely before surgery.

When regional chemotherapy is limited to only one body region or organ, the overall organism, despite the high local effects on the tumor, has fewer and fewer side effects. Not least because of the systemic detoxification by chemofiltration performed after each therapeutic procedure, 95% of the cancers tolerated extremely good treatment in all cases. Quality of life is less impaired, possibly even improved soon after treatment. Nausea and vomiting after treatment are observed extremely rarely. 

Treatment with systematic chemotherapy may interfere with or alter the circulation of the target area due to scarring. Intensive systematic chemotherapy can lead to resistance of the tumor tissue. This resistance can again be broken with regional chemotherapy by a local increase in the cytostatic concentration.

The greater the volume of the body affected by the tumor, the lower the chances of success because the total dose of administered chemotherapy is diluted more and more. As a result, the concentration effective at the site of infection decreases when the chemotherapeutic agent is distributed over larger areas. This goes along with less effekt.

The indication for regional chemotherapy, measured by the chances of success, is divided in three groups:

Tumors with good response:

  • Breast cancer (breast cancer and metastasis)
  • Head and neck cancer
  • stomach cancer
  • bladder cancer
  • prostate cancer
  • ovarian cancer
  • Cholangiocellular carcinoma
  • anal carcinoma
  • hypernephroma
  • thyroid carcinoma
  • esophageal carcinoma
  • carcinoid

 

Tumors with moderate to good response:

  • lung cancer
  • pancreatic cancer
  • Hepatocellular carcinoma
  • Soft tissue sarcomas
  • Malignant melanoma
  • cervical cancer

 

Tumors with poor to moderate response:

  • Colon and rectal carcinoma
  • Gallbladder carcinoma

 

This treatment is offered and performed in many places in Europe and the United States. Danish cancer sufferers go to Berlin or Frankfurt to receive this treatment which is far less adverse heavy than the conventional systematic chemotherapy that Denmark offers.

In Denmark, an experimental scheme is underway at Herlev Hospital, where regional chemotherapy is performed. However, Danish cancer sufferers are not immediately offered this treatment.