The choice of therapy procedure and the results of therapy depend upon a number of different factors, such as the blood supply of the tumour and whether the patient has undergone previous treatments (radiation therapy).
In the following section, we would like to describe several types of cancer and the chances for cure associated with them:
1. Mammary carcinoma - Breast Cancer
In breast carcinoma, arterial infusion through the artery that runs under the collarbone has proved its effectiveness. This artery supplies the breast and the chest wall as well as the lymphatic drainage regions on each side of the thorax. Treatment is performed in six cycles, with each cycle lasting five days and consisting of fifteen-minute arterial infusions with simultaneous blockage of the upper arm using an inflated blood pressure cuff. The treatment cycle is then repeated at four-week intervals.
If the tumour clearly regresses following the initial therapy cycle, then the patient has the option of deciding whether to consent to a surgical procedure to implant a permanent Jet Port Allround catheter, which makes treatment easier – or if she prefers instead to continue treatment with an angiographically placed catheter. The procedure was performed for the first time in 1986 and has been considered standard ever since.
- Amputation can almost always be avoided
- More than half of the patients treated show over 50% tumour shrinkage
- Complete disappearance of the tumour (clinically and histologically) in 25% of patients
- Side effects are very rare – hair loss in less than 5% of patients
- Drug streaming (a streaming phenomenon with skin and tissue irritation) in 4%
- Most patients are able to work between treatments
- Regional recurrence rate (T1 – T4: N0/N1) 17% during the interval between 9 and 16 years.
2. Mammary carcinoma – thoracic wall recurrence and lung metastases
Thoracic wall recurrences often occur scattered along the anterior and lateral chest wall and most of them tend to obtain all of their blood supply through a single artery. In order to simultaneously include all of the blood vessels that supply the tumours, we use isolated thoracic perfusion in these cases.
Regional chemotherapy for the thorax in the form of isolated thoracic perfusion with chemofiltration (ITP-F) is a very effective form of regional chemotherapy, which generates a very high cytostatic drug level in the thoracic area, but also results in high concentrations of cytostatic drug in the middle and lower areas of the body that could potentially lead to significant side effects in the absence of subsequent chemofiltration. However, by using the detoxification method, patients experience hardly any subjective side effects.
- For diffuse lung metastases in both lobes of the lung, the overall response rate is 71%.
- Complete disappearance of the tumours in 26% of patients. This is identical to the results of regional chemotherapy for the primary mammary carcinoma.
- Partial remission 45%
- Survival rates
- 75% of patients survive for 13 months
- 50% (median survival rate) survive for 20 months
- 25% survive for 3 years
- 10% survive for 10 years or more
- For previously treated thoracic wall recurrences (especially after prior irradiation) the response rates are significantly less favourable than for patients who have not been treated previously.
- Survival times in a total collective of 70 patients:
- 75% survive for 9 months
- 50% (median survival rate) survive 15 months
- 25% survive 27 months
- 10% survive 10 years or more
3. Advanced Ovarian Carcinoma
Therapeutic options for recurrent ovarian carcinoma are very limited. If there is a recurrence following combination chemotherapy with platinum-containing agents, life expectancy is poor. Until now, no further cytostatic drug combination has resulted in progress. Studies confirm that increasing the administered dosage of cytostatic agents greatly increases side effects, impairs quality of life and does not result in any prolongation of life.
Regional chemotherapy for ovarian carcinoma has the goal of breaking through resistance to cytostatic agents by means of an increase in regional effective concentration. Subsequent chemofiltration serves to reduce the anticipated increase in toxicity.
- Complete disappearance of ascites (fluid in the abdomen) after only two isolated abdominal perfusion treatments in 45% of patients
- Reduction of ascites by more than 50% in 18% of patients
- Significant reduction in pain and abdominal symptoms in 74% of patients
- Survival times:
- 75% of patients survive for 7.5 months
- 50% of patients (median survival rate) survive for 13 months
- 25 % of patients survive 30 months
- 9% survive recurrence-free for 5 years and longer (maximum 15 years)
- Side effects remain within limits:
- Bone marrow depression by WHO criteria II/II in one quarter (26%) of patients
- Nausea occurred in 20%.
4. Pancreatic carcinoma
Pancreatic carcinoma generally has a poor prognosis, since it is typically detected too late and, in addition, it is located near anatomically important structures such as the bile ducts and major blood vessels. At the time of diagnosis, only 10% of these tumours are still operable.
For regionally advanced pancreatic carcinoma, chemotherapy only prolongs life expectancy by 2 – 3 months to around 5 – 6.5 months. Patients previously treated with radiation and chemotherapy are rarely included in studies because of their poor prognosis and as a result, very few such studies exist. One study (Author: Berlin JD et al) reports a median survival time (50%) of 6.7 months in a large study with 322 previously treated patients, and a 25% survival period of 10.5 months.
More recent studies of advanced, inoperable pancreatic carcinoma using newer agents could not demonstrate survival rates greater than 20-25% survival beyond 1 year. Regional chemotherapy for regionally advanced, inoperable and previously treated pancreatic carcinoma is performed using combined therapy, consisting of microembolization through angiographically placed catheters, followed by isolated abdominal perfusion to prevent or treat peritoneal (abdominal lining) metastases.
- 75% survive 6 months
- 50% (median survival rate) survive 9 months
- 25% survive 18 months
- 30% survive 1 year and longer