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CHEMOTHERAPY DELIVERED DIRECTLY TO LIVER TUMORS CAN EXTEND OR HELP SAVE LIVES
ORLANDO, Fla. -- New research shows using a minimally invasive technique to deliver chemotherapy directly to the tumor can double the survival time of adult patients with colon cancer that has spread to the liver. In a related study, children with liver cancer who are considered beyond hope may be saved using the same chemotherapy technique, followed by liver transplantation.
Both studies were presented here today at the 24th Annual Scientific Meeting of the Society of Cardiovascular & Interventional Radiology (SCVIR).
Performed by interventional radiologists non- surgically, chemoembolization is a technique that delivers cancer-killing chemotherapy directly to the tumor, followed by the infusion of tiny particles that cut off the flow of blood to the tumor. Chemoembolization Buys Colon Cancer Patients More Time
In a University of Pennsylvania Medical Center study of 51 patients whose colon cancer had spread to the liver and who subsequently received chemoembolization, 86 percent (44) were alive after one year. Typically, less than half of liver cancer patients who undergo systemic chemotherapy survive for a year. The patients in the study survived an average of 2 years, versus an average survival time of 11 to 12 months for patients undergoing systemic chemotherapy, which delivers cancer-killing medication into the blood stream, where it travels throughout the body.
"This is not a cure, but it certainly gives these patients more time, and it's usually pain- free, quality time," said Michael Soulen, M.D., associate professor of radiology and surgery at the University of Pennsylvania Medical Center, Philadelphia. "These are patients who had failed systemic chemotherapy, so for them, there is no other option available."
Colon cancer is the third most common fatal cancer, with about 150,000 new cases a year, notes Dr. Soulen. Half of those patients die when the cancer spreads to the liver and becomes difficult to treat.
Chemoembolization is administered by an interventional radiologist, who makes a nick the size of a pencil tip in the patient's groin and advances a tiny tube, or catheter, to the artery that brings blood to the liver. Using a moving X-ray (fluoroscopy), the interventional radiologist can deliver chemotherapy directly the tumor. That is followed by infusion of an oil along with tiny plastic particles to block to the tumor's blood supply. Children With Liver Cancer Given a Second Chance at Life
In a Children's Hospital of Pittsburgh study of children with a form of liver cancer, 6 of 14 children who received chemoembolization have undergone liver transplant. Three of those children are alive. One has survived tumor-free for 8 years and is considered cured, while the others have survived tumor-free for 14 and 18 months, respectively. Three other children survived for 6 months, 3 years and 4* years, respectively, before succumbing to spreading cancer. One child is currently undergoing treatment and awaiting transplantation. The remaining 7 patients did not undergo liver transplant for a variety of reasons and succumbed to their disease. While some patients only received chemotherapy delivered to the liver, those who had chemotherapy combined with embolization fared better.
"Right now, it's the only hope for survival for these children," said Richard Towbin, M.D., radiologist-in-chief at Children's Hospital of Pittsburgh, Pa. "And even those who eventually died were given several more years of quality living."
The first treatment option for children with liver cancer is surgery to remove the tumor, followed by systemic chemotherapy delivered intravenously. The children in this study were not candidates for surgery because of the size and location of the tumor. Some had failed systemic chemotherapy or were not candidates for the standard therapy.
Transplantation without prior chemoembolization doesn't seem to work, said Dr. Towbin. It's unclear why, but it appears to be necessary to shrink the tumor and kill tumor cells in circulation before the liver is removed for transplantation, he said.
"Our goal is to get them to be transplant candidates," he said. "This is a new and avant garde approach."
Chemoembolization is performed while the patient is under general anesthesia. As in adults, the interventional radiologist makes a tiny nick in the child's groin and advances a catheter to the site of the tumor. Chemotherapy is followed by infusion of Gelfoam(tm) (tiny semi-soft gelatin-like particles) to plug up the blood source to the tumor. The procedure is repeated monthly until a liver enzyme test drops to normal. Treatment can take up to 18 months to complete.
Dr. Soulen's co-authors of a paper on the topic of chemoembolization in adults with colon cancer are: Catherine Tuite, M.D.; Richard Baum, M.D.; Richard Shlansky-Goldberg, M.D; Ziv Haskal, M.D; and Constantin Cope, M.D.
Co-authors of a paper on the topic being presented by Dr. Towbin are: Christopher Arcement, M.D.; Manuel Meza, M.D.; David Gerber, M.D.; Robin Kaye, M.D.; George Mazariegos, M.D.; Jorge Reyes, M.D.; and Brian Carr, M.D., Ph.D.
An estimated 5,000 people are attending the Annual Scientific Meeting in Orlando, Fla., of SCVIR, a professional society based in Fairfax, Va., for physicians who specialize in minimally invasive interventional procedures.
An interventional radiologist is a physician who has special training to diagnose and treat illness using miniature tools and imaging guidance. Typically, the interventional radiologist performs procedures through a very small nick in the skin, about the size of a pencil tip. Interventional radiology treatments are generally easier for the patient than surgery because they involve no surgical incision, less pain and shorter hospital stays.
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Copies of 1999 SCVIR news releases are available online at www.pcipr.com/scvir beginning Monday, March 22.
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