Applications for Regional Chemotherapy

We use a number of different techniques to administer RCT. They are designed in such a way as to keep the surgical interventions as minimal as possible. I. Arterial infusion through an angiocatheter. For arterial infusion, a catheter is inserted into an artery in the groin area under regional anaesthesia and its tip is directed into the tumour region under X-ray monitoring and placed there. Advantage: no surgery required Disadvantage: during treatment (3-4 days), the patient cannot get out of bed. Illustration: Angiocatheter in the celiac trunk for regional chemotherapy of liver metastases from a carcinoid tumour of the small bowel. These metastases are so well vascularized that they can be visualized with contrast material injected into the artery. II. Arterial infusion through a surgically implanted port catheter. In this method, a port catheter is implanted directly into the vessel supplying the tumour by means of a surgical operation. This makes it possible to treat the tumour as often as necessary without the need for any additional surgery. Advantage: the patient is mobile afterwards, since the arterial infusion can be performed by puncturing the port each time. The operation provides better information about the extent of the tumour. Disadvantage: surgery and its attendant risks III. Chemoembolization Chemoembolization is employed primarily for liver tumours and metastases. In this procedure, the thinnest blood vessels (capillaries) are blocked with microparticles, and the cytostatic agent is retained in the tumour area. In addition, blocking the blood vessels deprives the tumour area of its oxygen supply. IV. Isolated perfusion Isolated perfusion is also performed as part of a surgical operation. In this procedure, an organ or body region is isolated using catheter systems and this region is subsequently perfused with a high concentration of the cytostatic agent by means of an external pump. At the same time or just prior to the procedure, the tumour can also be heated (hyperthermia) and/or the oxygen content of the blood can be reduced after administration of the cytostatic agent (hypoxia). For some cytostatic agents, this can result in up to a tenfold increase in "poisonousness" (toxicity) for the tumour. Result: the tumour disappears more rapidly The following organs or body parts may be perfused in isolation: Thorax (lungs, thoracic wall and head) Abdomen Pelvis Liver Extremities (arm, leg) To remove excessive amounts of chemotherapy agents