Transarterial chemoperfusion (TACP)

What is regional chemotherapy?

Regional chemotherapy is a form of cancer treatment involving the local application of a chemotherapeutic compound right near the tumor. This way, the drug is only delivered to the cancerous cells and has less impact on the entire system of the patient. Consequently, doctors can administer the drug at a much higher dose, resulting in a stronger impact on the cancer cells in the majority of cases. By reducing the overall systemic burden, the side effects are reduced, contributing to a better quality of the patient's life during this demanding therapy. Regional chemotherapy is an umbrella term for a number of different procedures. The decision of which procedure to employ is made in collaboration with the patient while the pros and cons as well as the individual wishes of the patient are taken into account. &;

Who is eligible for regional chemotherapy?

Not all tumors will respond the same way to regional chemotherapy.

However, those patients with cancers which are hard to access owing to their location or other factors are likely to benefit from regional chemotherapy. It is essential that the cancer is well perfused, as the concept of regional chemotherapy only works if the tumor's blood supply is good. Further, regional chemotherapy is beneficial for tumors that only respond to extremely high drug concentrations of a chemotherapeutic agent, meaning that systemic chemotherapy would be to toxic for the patient. This allows treatment of the cancer cells with a substantially higher dose.

However, the tumor has to present as a so-called solid tumor for the therapy to be indicated. On the other hand, regional chemotherapy cannot be administered to conditions such as blood cancer, since this type of tumor spreads throughout the system. Similarly, in cases of cancers with extensive metastasis, meaning spread of tumor cells to distant areas of the body, regional chemotherapy is no option.

Particularly tumors such as lung cancer, ovarian cancer, pancreatic cancer, carcinomas of the prostate, liver cancer and breast carcinomas are eligible for this therapy. Nevertheless, whether or not to employ regional chemotherapy depends on a number of factors and is considered with regards to other treatment options.

Previous surgery and scar formation may have a negative impact on the therapy.

Course of the treatment

Regional therapy is aimed at reducing the tumor mass. This can make the subsequent surgical removal of the tumor easier in many cases. The procedure differs according to which method is selected.

Under X-ray guidance, an angiocatheter can be inserted via a vessel in the groin which is then advanced to the tumor site. Another way is to surgically insert a port catheter directly into the vessel feeding blood to the tumor. A port can remain in place for some time, providing a felxible way to deliver the chemotherapeutic agent.

In contrast, the chemoembolization procedure makes use of a chemotherapeutic drug as well as an additional drug aimed at keeping the substance inside the tumor for a long period of time. Embolization cuts off the vascular supply to the tumor, resulting in demise of the tumor as a result of oxygen shortage of the cancer cells.  By blocking the small blood vessels, the drug becomes concentrated and promotes cell death. Also in this procedure, a catheter is advanced to the tumor.

Isolated perfusion is yet another approach, involving the delineation of a region or the tumor itself, facilitated by a surgically inserted catheter system. Via an inserted pump, high concentrations of the chemotherapeutic compound can be delivered to the tumor. The downside of this technique are the potential surgical risks, as it requires the chest to be opened via thoracotomy.

In some cases, chemofiltration may follow, filtering the blood downstream of the treated organ. This is done in order to extract the toxic substances and to ensure that they do not enter the bloodstream.

Risks and adverse effects

All in all, this therapy is well tolerated. However, certain general risks, like surgical complications or allergic reactions to the drugs, cannot be ruled out. Nevertheless, the typical side effects of systemic chemotherapy usually do not occur.

How much does regional chemotherapy cost?

Regional chemotherapy can cost between 40000 and 50000 Euros depending on the respective procedure. While patients can certainly request their public health insurance companies for reimbursement, currently there is no standard coverage. The decision whether or not to cover the costs is decided on an individual basis for each claim and is topic of current discussions, given that reginal chemotherapy has not yet been incorporated into the catalog of benefits of the public health insurance providers.

Which clinics and doctors perform regional chemotherapy?

Reginal chemotherapy is usually coordinated and performed by interventional radiologists. After the procedure, patients are treated in the oncology wards of the associated hospital.

If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience.

Let us help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the field of transarterial chemoperfusion and are looking forward to your inquiry or wish for treatment.

Sources:

• www.ukgm.de/ugm_2/deu/umr_rdi/37330.html
• Ejournal: RöFO 01/2020