Chemoembolization, first-line treatment for liver cancer

New research by Jeff Geschwind, M.D., director of interventional radiology and associate professor at Johns Hopkins University School of Medicine, has shown that liver cancer patients, most of whom have inoperable tumours, could benefit from chemoembolization, a nonsurgical treatment option that delivers a high-dose of chemotherapy to the tumour while decreasing blood flow through the arteries feeding the tumour, known as embolization.

By reducing blood flow to the tumour, the embolic agent allows the chemotherapeutic drugs to remain localized to the tumour, decreasing harm to healthy tissues and allowing higher doses of the drugs to be used.

Two studies found that chemoembolization does not induce liver toxicity and can possibly offer patients additional months, and is safe for high-risk liver cancer patients who already have restricted blood flow in the liver due to portal vein thrombosis.

Geschwind says a safety study demonstrated that chemoembolization should be the standard first-line treatment for inoperable liver tumours because patients have minimal procedural toxicity and it is already proven to substantially increase survival.

The best chance for a cure is of course the surgical removal of liver tumours but unfortunately liver tumours are often inoperable because they may be too large, or have grown into major blood vessels or other vital structures and sometimes, many small tumours are spread throughout the liver, making surgery too risky or impractical. Surgical removal is usually only possible for one third of primary liver cancer patients and 90 percent of patients with metastatic (secondary) liver cancer. The patients' compromised liver function means that doctors must be careful that cancer treatments do not cause additional liver damage and toxicity, which could lead to death.

Chemoembolization usually involves a hospital stay of two to four days and is a recognized palliative treatment for unresectable tumours.

Geschwind says that chemoembolization offers patients a nonsurgical option that preserves healthy tissue, is well tolerated and has a short recovery time and it can be repeated to control tumour growth or progression, thereby extending life expectancy in the majority of cases.

The procedure involves using imaging for guidance and the interventional radiologist, who is skilled in using the vascular system to deliver targeted treatments throughout the body, threads a tiny catheter up the femoral artery in the groin into the blood vessels supplying the liver tumour. The embolic agents keep the chemotherapy drug localized to the tumour, while depriving the tumour of blood needed for its growth. The cancerous tumour is attacked from inside the body without medicating or affecting other parts of the body.

Other types of cancer can also carry a risk of liver cancer as the liver serves as a way-station for cancer cells that circulate through the bloodstream and these cells may grow and form tumours in the liver. As many as 70 percent of all people with uncontrolled cancer will eventually develop secondary liver tumours, or metastases, tumours formed by primary cancer cells that have spread from other cancer sites. One of the most common sources of metastatic liver cancer is from tumours of the colon and rectum. About 140,000 people in the United States are diagnosed with colon cancer each year, and roughly half of these patients will develop tumours in their liver at some time.

The research was presented at the 30th Annual Scientific Meeting of the Society of Interventional Radiology.