In the minds of people who have experienced chemotherapy in their environment, but even if this has not happened, very often awakens fear, painful and difficult situations, fatigue and helplessness. A battle against cancer that we think we can not win.
But this is not the reality. Chemotherapy, in the conventional routes of administration, intravenously or orally, in many cases is accompanied by certain side effects, such as hair loss, vomiting and diarrhea, pain in the head, muscles and joints and generalized malaise. Despite the advancement of science and technology in oncology, despite the use of new targeted innovative therapies and immunotherapies, chemotherapy is still the cornerstone of oncology treatment, but it is now being transformed and evolving, also through surgical oncology.
“Surgical science, with the active and effective treatments that exist today, finds application not only in early and limited disease, but also under conditions for certain types of cancer, and in advanced and metastatic disease”, points out Mr. Odysseas – Ioannis Zoras , Professor of Surgical Oncology Director of Clinical Surgical Oncology and Center for Regional Therapies of Metropolitan Hospital.
Cancer treatment has evolved significantly, including extensive and specialized surgeries in combination with topical chemotherapy in specific areas of the body. These are the so-called “regional chemotherapies”, which are applied to the abdomen (for metastatic cancers of the ovary, colon, appendix, stomach, small intestine or other types of cancer). peritoneal and primary peritoneal carcinoma), and in the extremities (upper and lower) for certain types of cancer such as melanoma and soft tissue sarcomas of the extremities.
“The administration of regional chemotherapy offers the possibility of administering high doses of drugs, which leads to high local efficacy while reducing the burden of systemic circulation and, therefore, with fewer side effects.
“The application of regional chemotherapy is a significant addition to the arsenal of Surgical Oncology, with the aim of complete control of the disease in the applied parts of the body, improving the quality of life of patients, and accompanied by fewer side effects and increasing their overall survival.” the doctor.
The first, chronologically, method of regional chemotherapy that was developed and concerns cancers in the abdominal area, is done with the use of intra-abdominal (intraperitoneal) chemotherapy, after the application of heat (41- 43 ° C) to improve the ability to penetrate the tissues. It was introduced under the name HIPEC (Hyperthermic IntraPEritoneal Chemotherapy) and was established in conjunction with the so-called cyto-Reduction Surgery (CRS), in which all intra-abdominal localized areas of cancer are widely excised.
CRS-HIPEC is indicated for a variety of cancers that occur in the abdomen and have advanced and metastasized to its inner part called the peritoneum. Primary cancers include mesothelioma and primary peritoneal carcinoma and metastatic cancers include metastatic cancers of the colon, appendix, ovaries, stomach and small intestine.
The application of regional intra-abdominal chemotherapy over the last decade has expanded with its administration, in the form of an aerosol, under high pressure conditions. This technique is called PIPAC (Pressurized IntraPeritoneal Aerosolized Chemotherapy) and is an innovative system of chemotherapy drugs that combines the advantage of great local efficacy with the reduction of systemic complications. It is indicated for symptomatic use in the most advanced cancers of the peritoneal cavity, which are assessed as non-operative and at the same time do not respond to systemic chemotherapy. It concerns metastatic cancers of the colon, appendix, ovaries, stomach, small intestine, but also of the pancreas, liver and bile ducts.
This method has very good results in the treatment of recurrent ascites and offers patients the best possible control of symptoms from the abdomen, while improving their quality of life. The application of the PIPAC technique does not involve complicated surgical procedures, apart from simple laparoscopy, biopsy, where needed from the peritoneum, and the administration of chemotherapy. Therefore the complications are rare and very mild, while the effectiveness in controlling the symptoms of the patients is very high.
“Based on similar oncological principles is the treatment method called isolated hyperthermic limb diffusion (HILP – Hyperthermic Isolated Limb Perfusion). Its use is indicated in cases of melanoma and sarcoma, when the disease is non-operative or recurrent, and is located exclusively in the upper or lower extremities. The circulation of the limb is isolated and through connection to the blood vessels, the treatment is administered in high doses, in the context of a closed circuit. The chemotherapeutic drug that is mainly used in these cases is melphalan.
All the above methods are performed under general anesthesia. There are specific criteria, indications and contraindications for the application of each method. “The oncological value of these treatments makes them integral components of the modern fight against cancer, when they are performed by experienced and well-trained staff”, concludes Mr. Zoras.
Writes:
Mr. Odysseas – Ioannis Zoras, Professor of Surgical Oncology Director of Clinical Surgical Oncology and Center for Regional Therapies of Metropolitan Hospital
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