Relatively new( its formation falls at the beginning of the seventies of the last century), the chemoembolization technique became the answer to the question of researchers about whether it is possible to introduce a chemotherapeutic drug into tumor tissue of the patient in such a way that it does not cause him the slightest harm.
By the beginning of the eighties - thanks to the development of oily chemoembolization - this problem was solved. Unfortunately, this technique made it possible to obtain only a short-term effect when acting on tumor tissues, but there was no complete cessation of blood flow in the vessels supplying cancerous growths.
At the beginning of the 21st century, special particles were developed - microspheres, which have the ability to accumulate a chemical preparation and then release it( for a sufficiently long period).
In this case, blood circulation is blocked in the tissues of the tumor itself, and a longer contact of the cytostatic drug with cancer cells is the guarantor of a more successful treatment of oncological diseases.
The concept of
The term "chemoembolization" in medicine refers to the treatment of cancer tumors of various locations.
During the chemoembolization procedure, a certain amount of the drug is injected into the lumen of the blood vessel supplying the cancerous tumor. Then, by means of a synthetic material called an embolizing agent, the vessel is clogged.
In the conditions of modern clinics, two types of this procedure are performed:
- Oil chemoembolization , consisting in the introduction of oily radiopaque substances( saturated with cytostatic drugs) with further embolization of the artery, blood supplying the cancerous tumor. A significant disadvantage of this type of chemoembolization is the inability to achieve irreversible or any long-term embolization of blood vessels. The most popular oily radiopaque preparations are etiodol and lipiodol.
- Chemoembolization by microspheres. Microspheres are polymeric granules that have the ability to absorb chemotherapeutic agents and help create an irreversible or very resistant embolization of blood vessels. They are able to maintain a significant dose of chemotherapy drugs for several weeks. The mechanism of using microspheres is as follows: before the procedure begins, the microspheres are saturated with the necessary chemotherapy. Controlling itself with the help of an angiographic device, the radiosurgeon brings the catheter to the artery supplying blood to the malignant neoplasm, after which it enters into the lumen of the vessel microspheres matched in such a way that their diameter coincides with the diameter of the tumor microvessels. Clogging the microvascular bed of the blood vessel, the microspheres completely stop the blood flow in it, after which the release of the chemotherapeutic drug occurs.
Application in medicine
Chemoembolization is a procedure mainly used for cancerous liver damage.
It does not matter whether this is a primary tumor or the result of metastasis of cancer that affects other internal organs( lungs, mammary glands, pancreas and stomach, large intestine, esophagus), as well as the retina of the eyes( often melanoma is metastasized to the liver).
Chemoembolization is equally successful in patients with
- with hepatocellular carcinoma( primary liver cancer) or hepatoma;
- lung cancer;
- with kidney cancer;
- with large and small intestine cancer;
- with pancreatic and breast cancer;
- with bladder cancer;
- from the metastasis of malignant neoplasms to other internal organs.
The chemoembolization procedure can be used both as an independent treatment method and as an additional therapeutic method, along with chemotherapy, radiofrequency ablation and irradiation.
About procedure
At the moment the chemoembolization procedure is the leading therapeutic method in the treatment of a number of oncological diseases.
Chemoembolization can also be used to relieve symptoms in patients with unresectable cholangiocarcinoma.
Preparation of
Conducting chemoembolization requires careful preparation of the patient.
- Approximately one week before the scheduled operation, the patient should consult with a specialist who will perform it. During the consultation, the patient is obliged to inform his X-ray surgeon about what medicines and herbs, food supplements and vitamin complexes he takes. Information about the presence of an allergic reaction to medications used during chemoembolization is equally necessary. This category includes antibiotics, drugs used for local and general anesthesia, as well as iodine-containing radiopaque substances. If necessary, an X-ray surgeon may recommend the discontinuation of a number of medications( a few days before chemoembolization, it is especially undesirable to take warfarin, anti-inflammatory non-steroid drugs, and aspirin).A special conversation requires information about the presence of pregnancy in women who are going to undergo chemoembolization, because X-rays can be fatal to the fetus in the womb. Being warned about pregnancy, specialists will choose such chemoembolization tactics, which in no way will harm the future baby.
- A few days before the procedure, the treating specialist will necessarily instruct the patient about how to change the schedule for taking medications and how to prepare for the operation. Before entering the clinic, the patient should carefully shave the groin area and axillary cavities.
- If chemoembolization involves the administration of a sedative, the patient will be warned about the need to abstain from food and drink for eight hours preceding the operation.
- It is desirable, if the patient is delivered to the clinic by an attendant, who can spend some time with the patient after the procedure. In a medical institution, the patient should arrive approximately one day before the prescribed procedure.
- For children, the chemoembolization procedure is performed under general anesthesia. In this case, parents receive additional instructions from the anesthesiologist.
What equipment is used?
A large amount of medical equipment is required for chemoembolization, but a special X-ray machine and a miniature catheter that allows to enter a vessel that supplies blood to a tumor is of utmost importance.
X-ray machine necessarily contains:
- large monitor;
- special table on which the patient is placed;
- X-ray tube.
The catheter looks like an oblong plastic tube, the diameter of which is much smaller than the circumference of the pencil. With its help, in the lumen of a vessel feeding a cancerous tumor, it is possible to introduce a variety of various embolic agents: substances that contribute to narrowing and complete blockage of blood vessels.
As such agents, microspheres( granules made of polymers) or oils are used.
Required equipment, without which no chemoembolization procedure can do, is an intravenous catheter, through which the medications are quickly introduced into the patient's body.
Equally important for performing this manipulation are devices that allow monitoring the patient's vital signs( pulse and arterial pressure), as well as a system for the infusion( injection) of analgesic sedatives.
How does the method work?
During the procedure of chemoembolization of the liver, the impact on malignant neoplasm is carried out in two ways:
- Thanks to an intravenous catheter, antitumor drugs are delivered directly to the affected liver tissue. The advantage of this method of drug delivery is that a high concentration of cytostatic agents is created in the lesion focus, while the organism as a whole is not exposed to serious toxic effects.
- During chemoembolization, the blood supply of a malignant tumor is discontinued. As a result, a cancerous tumor, deprived of fresh blood, is in the center of a closed space filled with a potent antitumor drug. Cancer cells that find themselves in conditions of oxygen starvation aggravated by the action of cytotoxic drugs begin to die, leading to a significant decrease in the tumor.
How does the procedure work?
- The procedure for superselective chemoembolization is one of rather difficult, although not very traumatic, operations that usually require the use of local anesthesia. General anesthesia is used in extremely rare cases.
- Performing chemoembolization requires the availability of a qualified X-ray surgeon and the sterile conditions of a conventional operating room or a specialized X-ray room.
- Immediately before the procedure, the treating specialist performs an X-ray examination that allows you to view the blood vessels supplying the tumor with blood. To do this, an X-ray contrast substance is injected into the blood of the patient, allowing a clear image on the monitor to help track the progress of the catheter along the vessels.
- After informing the patient about the possibility of complications and individual reactions of the body, the X-ray surgeon takes informed consent to the operative intervention.
- After fulfilling the documentary formalities, the treating specialist begins to saturate the microspheres with the drug.
- To minimize the damage to the kidneys with chemotherapy and the products of the disintegration of tumor tissue, the patient is prescribed the intake of allopurinol. Antibiotics help prevent the risk of infection after the procedure. To control pain and nausea during the preoperative period, special medicines are used.
- With the help of an X-ray surgeon, the patient is placed on the operating table, his body is covered with sterile underwear and special devices are connected to him, helping to control blood pressure, pulse fullness and heart rate.
- The operating sister sets up a system for intravenous( infusion) sedation. Sometimes a patient needs general anesthesia.
- The site of the future puncture is processed by the X-ray surgeon with solutions of anesthetic substances so that the patient continues to remain conscious, could consciously answer the questions, but did not experience any pain.
- Having performed a very small puncture or a pinhole cut of the skin, the specialist, guided by the indications of the X-ray apparatus, gently inserts a miniature rubber catheter into the lumen of the femoral artery and gradually moves it towards the hepatic artery. After the introduction of the radiopaque substance, the doctor performs a whole series of liver imaging.
- Immediately after the catheter has reached a branch of the hepatic artery that supplies blood to the malignant neoplasm, the X-ray examiner mixes the embolizing agent with the antitumor drug and injects the resulting medicine into a blood vessel. To verify the success of the embolization, the doctor performs several additional X-ray images.
- Having completed the procedure, the X-ray surgeon removes the catheter, stops the bleeding and applies a sterile pressure bandage to the surgical wound. Since the wound has small dimensions, there is no need for suturing.
- The average duration of the chemoembolization procedure does not exceed one and a half hours.
- At the end of the operation, the patient is transferred to the ward, where he remains under the supervision of specially trained medical personnel. It is necessary to be in bed for at least six to eight hours.
Chemoembolization of the liver
The mechanism of chemoembolization of the liver is based on a unique structure of the liver, which has two channels of blood supply: one of them is portal( portal) vein, and the other - the hepatic artery.
Large( up to 75%) part of the blood enters the healthy liver through the portal vein, and only 25% through the hepatic artery.
When a malignant neoplasm develops in the liver, the main supplier of blood to the affected tissue is the hepatic artery.
Side effects of
Following the chemoembolization procedure, the overwhelming majority of patients have:
- The development of postembolization syndrome is a complex of side effects that is a reaction of the body to injected chemicals and includes attacks of nausea and vomiting, fever and pain. Given that most of the chemotherapy remains in the liver, the severity of these side effects is insignificant.
Pain due to cessation of circulation in the affected tissues is the most common side effect of chemoembolization. To stop the pain syndrome, intravenous injection of morphine or oral administration of non-steroidal anti-inflammatory drugs is practiced.
As a rule, patients who have undergone a chemoembolization procedure leave the hospital immediately after the normalization of the condition, manifested by a reduction in pain and the cessation of nausea. Usually this happens at the end of the first-second day after the operation. To stabilize the condition after discharge, they are prescribed antiemetics, analgesics and antibiotics that help prevent the development of infection.
Elevated body temperature can be observed within a week after the procedure. It is quite normal phenomenon, observed for two to three weeks, is considered increased physical weakness and decreased appetite.
- Hair loss.
- Change in blood characteristics: decrease in leukocyte count( so-called leukopenia) and decrease in the number of platelets( thrombocytopenia).
- Anemia is the clinical-haematological syndrome of , characterized by a decrease in the concentration of hemoglobin and a decrease in the number of red blood cells in the blood.
Conducting chemoembolization in children can trigger the formation of blood clots in the vessels of the lower limbs.
Serious complications after chemoembolization are observed in every twentieth case.
The greatest danger is the infection of the liver and damage to its tissues. As shown by medical statistics, for 1% of patients the chemoembolization procedure ends with a lethal outcome. All patients who did not undergo the procedure had a significant impairment of liver function.
Advantages and disadvantages of
The chemoembolization procedure has a number of undoubted merits:
- In 75% of patients who have undergone this complicated, although not very traumatic, operation, the malignant liver tumor either ceases to grow for some time, or decreases substantially in size. The duration of the therapeutic effect depends largely on the type of malignant neoplasm and can persist for ten to fourteen months. In case of resumption of the tumor process, the chemoembolization procedure can be repeated.
- Chemoembolization works well with other methods of antitumor therapy ( it can be tumor ablation, radio and chemotherapy).Complex use of these methods of treatment allows to control the growth of malignant neoplasm.
- Because the death rate of patients with liver cancer in most cases is due not to metastasized tumors to other organs, but to severe liver failure in the context of the rapid growth of malignant neoplasm, chemoembolization procedure can greatly improve the quality of life of patients. Thanks to her, it is possible not only to stop the growth of the tumor, but also to improve the functioning of the liver.
The chemoembolization technique also has a number of disadvantages, since it involves certain risks:
- As a procedure requiring a breach of the integrity of the skin, chemoembolization is associated with a risk of infection. However, the probability of infection of the operating cavity is not too high( it is not more than one case per thousand operations performed).
- Another category of risks in chemoembolization is caused by the need to insert a catheter into the lumen of the blood vessel. The most common complications in performing this manipulation are: the risk of damaging the vascular walls, the development of bleeding and hemorrhages in the area of insertion of the catheter, and the infection of this zone.
- The risk of penetration of the embolizing drug into cells of healthy tissues is quite large: this can lead to a violation of their blood supply and nutrition.
- The risk of infection of the operating wound is high enough for even if antibiotics are prescribed.
- In some patients( such cases are quite rare) , an allergic reaction of to the contrast agent administered during angiography, an integral part of the chemoembolization procedure, may occur.
- This same contrast agent in rare cases can become the culprit of kidney damage in patients with , suffering from severe pathology of this organ or in patients with diabetes mellitus.
Contraindications to
Contraindication to chemoembolization is the presence:
- Severe hepatic insufficiency.
- Serious disorders in the functioning of the kidneys.
- Bile duct obstruction.
- Serious problems with blood coagulability.
Patients' comments about chemoembolization
Tatyana:
My mother is 72 years old. Breast cancer gave multiple metastases to the liver. After a year of chemotherapy, she was prescribed a chemoembolization procedure. During the next medical examination, she was diagnosed with diabetes mellitus and another concomitant disease - chronic pancreatitis. After the ultra-selective chemoembolization( cytostatic preparations of eloxatin and lipoidol were used), a significant deterioration in the state of health was observed, and very severe pains appeared, which were of a circumcised nature. The attending physician explained that all this is the result of exacerbated pancreatitis. By the evening of the next day, my mother's body temperature rose to 37.6.After receiving the tests( they turned out to be normal), my mother was discharged from the hospital on the fourth day after the operation. The tactics of further treatment include two courses of chemotherapy according to the MMM scheme( a combination of mitoxantrone, mitomycin and methotrexate) and another chemoembolization procedure. After the second course of chemotherapy, control will be carried out.
Ludmila:
My mom also went through this operation several times. The first hours after the procedure were always extremely painful. Since during the first day the patient is forbidden to get out of bed, we at this time resorted to the care of a nurse. Her body temperature also rose insignificantly and stayed for two weeks.
Prices
The cost of chemoembolization procedure of the liver consists of many components. The most important is the class of the clinic where the treatment will be conducted, the qualification of the treating specialists, and the number of additional studies.
Of no small importance is the country in which this medical service is provided.
The approximate pricelist of quotations is presented by us in the following table:
- In Russia the chemoembolization procedure will cost the patient 160 000 rubles.
- In Ukraine, the patient will pay for her UAH 90,000.
- The cost of the procedure in Israel is 7,000 dollars.
- In German clinics for chemoembolization of branches of the hepatic artery, 6,000 euros will be required.
Video about chemoembolization in oncology: