FEATURE MEDIAS KLINIK
genTly does iT... W
hen a 37-year-old seemingly healthy male was brought into Medias Klinikum GmbH & Co.
KG (a private clinic in Germany) following a traffic accident, doctors attending to him were taken aback to discover cancer cells in his bowels, with the disease having spread to the liver.
“The patient was unaware of his
condition,” remembers the operating surgeon, Prof. Dr. Karl Reinhard Aigner. “The accident had caused a rupture of the spleen, and while undergoing surgery for this, his cancer condition came to light.” After removing the cancer tissue, the
patient was referred to an oncologist for chemotherapy treatment. “When I saw him four months later, he was bald and looked pale due to the chemo sessions. His stomach was full of metastases and he was swollen. The man was in a lot of pain while his two young daughters wept at his bedside.” This incident had a profound effect
on Dr. Aigner. “I hated the thought of my children going through such emotional trauma if something were to happen to me. But more importantly, as a doctor, I was concerned about the nature of systemic chemotherapy, which is the conventional mode of treatment for cancer. What purpose did it serve if the cancer returned and the patient had no respite from pain?”
The convenTional way Systemic chemotherapy involves administering the drug orally, or by injection. The drugs enter the bloodstream and travel to all parts of the body. While it kills cancer cells, it also kills the healthy cells in areas like the hair follicles, bone marrow, and the mucous membrane of the digestive tract, leading to side effects such as hair loss, mouth and throat sores, nausea and vomiting, and gastrointestinal irritation. The questions that plagued Dr. Aigner
were: Why is the entire body of the patient treated when the problem lies in one particular organ or area only? And what would happen if the medication were
administered only to the affected organ? 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 perceived, even by the medical fraternity. Thirty years ago, being diagnosed with cancer was akin to being given a death sentence. In the case of breast cancer the patient knew that she would have to undergo mutilating surgery. “I
“
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 in 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
in systemic chemotherapy, the aim is to reach the tumour as well as potential distant metastases
clearly remember how, as a young assistant in my first year, the chief of surgery was on the phone to 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 – the woman
lying there was only about 30 years old, but then, in 1979, amputations were frequently used even when cancer of that organ was only suspected. It struck me as odd that nobody gave any thought to how the patient was feeling,” he says. “This is the essential factor of what I am doing: I try to feel like the patient. What would I do if I had cancer?” In systemic chemotherapy, the aim is to
reach the tumour as well as potential distant metastases. But the problem here is that the drug will be diluted, and although it potentially reaches all distant micro metastases, in most cases the concentrations are too low to really affect the tumours. An increase of dosage, however, would further increase side effects and toxicity to the patient.
Regional chemoTheRapy So, how do you 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. It was by handling the available
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. The goal of regional chemotherapy is to harm the tumour more than the patient, he adds. “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 entire body. RCT is tolerated well by 95% of all patients; they don’t suffer from either nausea and vomiting, or hair loss and other infections, as the entire body is not exposed to the drug. As such, quality of life is rarely 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 that is carried out after the therapeutic surgery. Dr Aigner’s goal has always been to relieve pain, and RCT has proved to be an effective therapy in this regard. However, he cautions that not all
” ARAB HEALTH SERVICES DIRECTORY 2012 33
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