Life & Style | Health
Gently does it
A more targeted form of treatment of certain types of cancer is improving chances of recovery even as it reduces the scope of collateral cell damage.
- By Sangeetha Swaroop, Dubai-based freelancer
- Published: 23:01 June 25, 2009
- Image Credit:
A more targeted form of treatment of certain types of cancer is improving chances of recovery even as it reduces the scope of collateral cell damage. Sangeetha Swaroop speaks to Prof Dr Karl Reinhard Aigner who is bringing this treatment to Dubai Healthcare City.
When a seemingly healthy 37-year-old male was brought into a private hospital in Germany in 1979 following a traffic accident, doctors attending to him were taken aback to discover the growth of cancer cells in his bowels, with the disease having spread to the liver.
"The patient was unaware of his condition," says Prof. Dr Karl Reinhard Aigner, the surgeon who operated on him. Currently head of oncologic surgery at Medias Klinikum GmbH & Co. KG, in Burghausen, Germany, Dr Aigner opened the Medias Klinik in Dubai Healthcare City in March.
He explains the case history of that patient. "The accident had caused his spleen to rupture, and so the cancer was only discovered during surgery." After removing the cancerous tissue, the patient was referred to an oncologist for chemotherapy. "When I saw him four months later, he was bald and looked pale due to the chemo sessions. His entire belly was full of metastases (secondary cancer that has spread to other regions of the body), and he looked very bloated. The pain was causing him extreme distress and he would often scream in pain, as his daughters would sit by his bedside and weep at his distress."
While heartbreaking scenes like these are perhaps an everyday situation in critical illness wards in hospitals, this incident was to have a profound effect on Dr Aigner, who at the time, had daughters about the same age as the patient.
"I shuddered to think of my children going through such emotional trauma if something untoward were to happen to me," he says. "But more important, as a doctor, I was concerned about the very nature of systemic chemotherapy which is the conventional treatment for cancer. What purpose did it serve if the cancer recurred and the patient had no respite from pain?"
Systemic chemotherapy involves administering drugs orally or by injection. The drugs enter the bloodstream via the vein and travel to all parts of the body. But while they kill cancer cells, they also kill healthy cells in the hair follicles, bone marrow and the mucous membrane of the digestive tract. This leads to side-effects such as hairloss, mouth and throat sores, nausea and vomiting, gastro-intestinal irritation, and so on.
The questions that plagued Dr Aigner's were: why is the entire body of the patient treated when the problem lies in one particular organ or area? What would happen if the medication was administered only to the affected organ?
He resolved to find ways to treat the tumour directly, "as my concerns arose from logical thinking," he says.
While this particular case was the key incident that eventually brought him to the technique of regional chemotherapy, Dr Aigner had always been troubled about the way cancer was dealt with, even by the medical fraternity.
"Thirty years ago, being diagnosed with cancer was akin to being given the death sentence. In the case of breast cancer, for instance, the patient knew that she would have to undergo mutilating surgery.
"I remember clearly how as a young assistant in my first year, the chief of surgery was on the phone in the operating room with the pathologist, wanting to know if the tests of the patient lying on the table revealed the presence of cancer cells or not. He had just excised a lump in her breast, and though the pathologist couldn't say for certain, an instantaneous decision was taken to remove the breast.
"I was horrified and shocked at the way the matter was dealt with the woman lying there was only about 30 years old, but then, the year was 1973 and at the time, amputations were frequently used even when cancer of that organ was only suspected, not proven beyond doubt.
"Yet, what struck me as odd was that nobody gave a thought to what the patient was feeling," he says. "And this is at the core of what I am doing: I try to feel like the patient. What would I do if I had cancer, I ask myself. I know I would want the best therapy, one which also ensures the best quality of life for me subsequently."
According to Dr Aigner, "In systemic chemotherapy, where the tumour and the entire body of the patient are treated at the same time, the aim is to reach the tumour as well as potential distant metastases. But the problem in doing so is that the drug will get diluted, and although it potentially reaches all distant micrometastases, in most cases, the concentrations are too low to really affect the tumours. An increase in dosage, however, would further increase side-effects and toxicity in the patient."
His aim, therefore, was to target the tumour directly. "The focus should not be on improvement of survival time by a few months if it is at the cost of increased prices and reduced quality of life," Dr Aigner says. "I was concerned that all the so-called new 'weapons' against cancer marginally increased the cost of drugs without providing proportionate benefits to the patients. The aim of all therapeutic endeavours, I believe, should be to damage or destroy the tumour and salvage the patient's life thereby ensuring good quality of life."
And thus it was by handling the available drugs in a better way that he developed a special form of chemotherapy that attacks the tumour in a sustained fashion because of its highly concentrated action. Called regional chemotherapy (RCT), this new mode of treatment refers to the application of chemotherapy in the area of and around the tumour. It is also known as local chemotherapy because of the intensified impact on a region of the body.
Dr Aigner explains, "We inject the drugs via the artery directly into the blood vessels that supply the tumour or the region of the body affected by the tumour. A very high concentration of anti-tumour agent in the target area leads to a higher transfer into the tumour cells and therefore to a superior and more rapid drug effect in the target area.
"It works like the fire department," he explains. "We aim our hoses at the actual source of the fire and not at the intact surroundings."
The goal of regional chemotherapy is to harm the tumour per se and not cause collateral damage. "As a rule of thumb, six times the concentration achieved under traditional chemotherapy is necessary to thoroughly damage a solid tumour."
While the strong local effect on the tumour is the most distinct advantage to this type of treatment, what is equally heartening is that there are hardly any side-effects as regional chemotherapy is always restricted to only one region or one organ in the body.
"RCT is tolerated well by 95 per cent of all patients; they suffer neither nausea nor hair loss, or vomiting and other infections as the entire body is not exposed to the drug," he says. "As such, quality of life is seldom impaired. Between treatments, patients can lead a normal life, and usually hold down a normal job." Side effects are also minimised because of the process of chemofiltration or de-poisoning that is carried out after the therapeutic surgery. "My ultimate goal has always been to relieve pain, and RCT has proved to be an effective therapy in this regard," he says.
However, he cautions that not all forms of cancer can be treated using the regional chemotherapy method, as some are not suitable for highly concentrated chemotherapy. "RCT is best suited for patients with solid tumours. The redeeming aspect of this method is that it works right away, or not at all," he says.
Cancers in organs generally show a good response rate to regional chemotherapy, he says. These include breast and lung cancer, carcinomas of the stomach, liver, pancreas, prostate, bladder, ovaries and colon, and head and neck tumours.
Just as in conventional cancer treatment, the greater the proportion of the body affected by the tumour, the smaller the chances of success. While tumours in their early stages are good to treat with regional chemotherapy, Prof. Aigner and his team have achieved excellent results even in late stages and supposedly hopeless cases.
"Most of the patients who come to us are those who have not responded well to chemotherapy or those who have had a relapse. Various medical studies have published results pointing to convincing data in terms of tumour response, quality of life and survival of those treated with RCT.
For instance, it's well known that pancreatic cancer, a killer cancer, responds well to RCT when other chemotherapies fail. Breast cancer too has been treated with almost no side effects and without amputation. The response rate of breast cancer has been 80 to 95 per cent with RCT.
"Additionally, even advanced cancers of the bladder and the prostate are treated by means of the isolated pelvic perfusion technique with chemofiltration, thus avoiding mutilating surgery, impotence and incontinence," he says.
Isolated perfusion is one among the three main techniques of regional chemotherapy, he explains. "Here, the specific organ's blood supply is separated from that of the rest of the body, allowing chemotherapy to be administered directly to the organ in amounts that would not be safe if it is circulated throughout the body. The result is that the tumour disappears more rapidly."
Interestingly, Prof. Aigner, a German surgeon who initially had his training in cardiovascular surgery and later specialised in cancer surgery, was familiar with the technique of isolated profusion of the limb first performed in the US in the 1950s. In 1981, he became the first surgeon worldwide to develop and safely perform a technique of isolated perfusion of the liver with a heart-lung-machine a process that is similar to a bypass surgery of the heart. It took more than 15 years for this method to be accepted by the National Cancer Institute in the US where currently, it is performed as a routine procedure.
After having developed the technique of isolated liver perfusion, Dr Aigner continued his endeavour to isolate all different body parts, segments and organs of the body with the latest development being the isolated perfusion of the upper abdomen. Though these techniques are not new, their practice has been limited primarily because technical skills and sufficient experience are required to perform it properly with good results.
Elimination or reducing side-effects to the patient through the chemofiltration or detoxification process ensures that the patient's quality of life is protected during the intensive treatment.
Looking back on his almost 30 years of experience with regional chemotherapy, Dr. Aigner says that RCT is an extremely effective method in cancer therapy that is well tolerated by patients causing no side-effects in most cases. It increases the survival rate of the patient just not by a few months, but many years.
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