Another use for lasers: increasing lifespan of liver cancer patients
(HealthDay News) Oncologists are calling it a "smart bomb" treatment, and it may some day give thousands of patients with hard-to-treat cancer a new lease on life.
The combination of shrinking a malignant tumor with chemotherapy using a laser to burn away the remains was first reported in a German trial on liver cancer patients in 2003. Those who had the combo treatment lived more than twice as long as the patients who didn't have laser surgery.
The combination therapy also greatly reduced recovery time when compared to the standard surgery treatment, says Dr. Jonathan Susman, associate professor of radiology at Columbia University in New York City . The researchers say the dual treatment has applications for lung, bone and lymph node tumors as well.
Liver cancer remains one of the deadliest cancers, however, and even cutting-edge treatments don't prevent recurrence in many patients with the most advanced forms of the disease.
"Traditionally, patients have been plagued by poor survival," says Dr. J.F. Geschwind, section chief of interventional radiology at The Johns Hopkins Hospital in Baltimore . Even after doctors remove the liver tumors through surgery, they return within five years in 75 percent of cases, he says.
Liver cancer is especially difficult to treat because it's often the result of existing liver disease, such as cirrhosis or hepatitis. "You can even consider it a side effect, no question about it," Geschwind says.
In other cases, liver cancer develops when tumors migrate from other parts of the body, especially the colon or breast.
An estimated 21,370 cases of primary liver cancer are expected to be diagnosed in the United States this year, according to the National Cancer Institute. It is an insidious disease, with an estimated 18,410 deaths in 2008. Most patients are men.
Doctors can try to burn up the tumors with lasers and high-frequency radio waves. However, tumors with diameters of more than 3 or 4 centimeters are often too large to be treated effectively.
"You never know how much of the tumor you burned," Geschwind says. "If you leave a little bit of the tumor behind, it returns with a vengeance."
In the study, the researchers from University Hospital in Frankfurt , Germany , recruited 162 liver cancer patients whose tumors were large and came from cancer that had been elsewhere in the body. The doctors tried to shrink the tumors and then, if possible, destroy them with lasers.
All the patients had a treatment called chemoembolization to shrink the tumors. "We inject the chemotherapy right into the tumor cells, and then cut off the oxygen supply by blocking the blood flow," says Susman, who uses that approach to treat his patients.
The research showed that tumors shrank in more than half of the patients. Doctors went on to treat their tumors by burning them with lasers. Susman uses a similar approach, utilizing radio-frequency waves instead of lasers. The research first appeared in the journal R adiology .
"I treat [the tumor] from the inside first to hamper its defenses and shrink it down, so that I can use a device to burn it away and completely eradicate it. It is the medical equivalent of a smart bomb," he says.
Blocking blood flow to the tumor helps in the burning process, Susman adds. "The blood supply works like the radiator in your car, pulling heat away. When we block the blood supply you no longer have the radiator circulating. You heat the tumor more easily because the heat doesn't go away."
The patients who underwent the combination treatment lived for a median of 26.2 months, while the other patients who only received the chemoembolization lived a median of 12.8 months.
Those survival rates may seem low, Susman says, but they'd be higher in patients with smaller tumors. Also, the treatment lets patients avoid surgical removal of tumors, which requires months of recovery time and poses great risks, he adds.
On the Web
To learn more about liver cancer, visit the National Cancer Institute Web site.
J.F. Geschwind, M.D., associate professor, radiology, surgery, and oncology, and section chief, interventional radiology, The Johns Hopkins Hospital, Baltimore; Jonathan Susman, M.D., associate clinical professor of radiology, College of Physicians & Surgeons of Columbia University and clinical director, vascular and interventional radiology, New York Presbyterian Hospital/Columbia New York City: November 2003 Radiology
Publication date: April 2008
Randy Dotinga, HealthDay Reporter
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