Improving Cancer Therapy Benefits: Combining Regional Chemotherapy and Standard Treatments

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Improving Cancer Therapy Benefits: Combining Regional Chemotherapy and Standard Treatments

improving cancer therapy benefitsAttaining therapeutic benefits for cancer patients through chemotherapy is by far one of the most common methods in modern oncology. It is also not a new approach. New drugs are released, but the modes of administration remain almost the same throughout the years. Similarly, side effects and cancer remission rates remain somewhat statistically predictable with standard treatment protocols alone. Although there are significant variations from one patient to another, there is a baseline.

However, new procedures usually become available to a wider public, when they prove to be safe, show good efficacy and economic efficiency. Regional chemotherapy (RCT) fits those criteria, but the latter. Unlike systemic chemotherapy, it requires highly specialized team to administer and, therefore, the cost of the therapy increases.

But what is regional chemotherapy about, and what is the difference between systemic and regional chemotherapy administration? What types of cancer show positive results with regional chemotherapy alone and in combination with other therapies?


The theory behind regional chemotherapy benefits

Systemic chemotherapy is the standard cancer treatment in which drugs are injected into the systemic circulation. This approach allows drugs to reach relatively similar concentrations in all of the body tissues. Systemic method is usually intravenous, but there are some orally administered chemotherapeutic agents as well. Since systemic chemotherapy reaches all throughout the body, it has a significant role in preventing metastasis. However, a systemic approach also increases the risk of severe side effects and potential organ failures, particularly with a prolonged use of stronger cytostatic agents.

Regional chemotherapy can utilize the same drugs as systemic administration while improving cancer therapy benefits. The most important change is the mode of delivery. It is usually administered introarterially to reach tissues and organs irrigated by particular arteries. The goal is to attain very high concentration of chemotherapeutic agents in a short period of time and only in the areas affected by the tumors. Regional chemotherapy has many variants, such as intraarterial infusion, isolated perfusion, chemoembolization or top flow infusion.


Regional chemotherapy advantage

A distinct advantage of regional chemotherapy in all of its variants is that it increases the concentration of the drugs in the cancer-affected area. Often higher concentration of the drug equates to higher efficacy, improving cancer therapy benefits. Furthermore, regional chemotherapy aims to reduce the exposure of additional tissues to the chemotherapy agents, thus, minimizing the risk of severe adverse effects.

Both systemic and regional chemotherapy have critical applications, and they are both useful in the fight against cancer. However, in some cases, a combination of the benefits of both procedures may be a good option. Such approach may help to break through tumor resistance and to maintain the patient. Using regional chemotherapy as a primary therapy for advanced cancers has proven to be a powerful tool when the standard treatment is no longer effective. In the medical practice, physicians may decide to apply regional chemotherapy in selected pathologies such as head and neck cancers, breast cancers, lower extremity melanoma, lung cancers and many other.


Regional chemotherapy in the medical practice

The success of regional chemotherapy is not only theoretical. In the clinical practice, patients with metastatic sarcoma in the lungs show a clear benefit from lung perfusion treatments. In many cases, systemic chemotherapy fails to deliver adequate drug concentration to the lungs. The clinical experience indicates that in some cases systemic chemotherapy does not have desired response rates in cancer patients. However, in an attempt to reach a therapeutic concentration, lung perfusion (isolated thoracic perfusion) delivers larger doses of chemotherapeutic agents. This may trigger better tumor response, improving cancer therapy benefits and minimizing side effects associated with systemic chemo. Finally, combined therapy can allow to treat pulmonary and extrapulmonary metastasis, which the patients may experience.

Colorectal carcinoma has also been treated with high-dose regional chemotherapy administered through arterial infusion. Hepatic (liver) metastases respond to regional chemotherapy treatment as well. Importantly, the outcomes of this approach increase the response rates while minimizing toxicity to the healthy organs.

Patients without peripheral vascular disease suffering from melanoma in lower extremities have also found benefit in regional chemotherapy. Oncological surgeons with experience in the RCT procedure and the management of the patient usually deliver the drugs through the iliac arteries. Mild edema, erythema and discomfort may follow the procedure, but moderate to severe toxicity is uncommon. Regional toxicity is avoidable by the use of blood chemofitration, following regional chemotherapy, thus, minimizing potential side effects. Systemic leakage is usually less than 10%.

Other successful organs and tissues in which regional chemotherapy increases the therapeutic response are pancreatic cancer, ovarian cancer, gastric cancer, peritoneal surface malignancies and even brain cancer, among others. Some of the patients show better response rates when regional chemotherapy is the primary strategy. Further combining it with other treatments, such as systemic chemotherapy, radiotherapy and new emerging therapies can be also beneficial.


Improving cancer therapy benefits by combining therapies 

Cancer is a multilayered and complex disease and is usually treated with a combination of therapeutic options. Regional chemotherapy is not the exception to this, and joining the benefits of a regional approach along with a systemic therapy and other techniques such as radiation therapy has increased survival rates in the clinical experience. As regional chemotherapy increases the concentration of the drugs limited to the tumor and its surroundings, as well as metastases, systemic therapy can fight remaining cancer cells in the blood stream. By joining both treatments in a combined strategy, the systemic toxicity levels of the drugs can be minimized.

For localized cancers, a combination of regional chemotherapy and radiotherapy might be a suitable option for improving cancer therapy benefits. In all cases, patients should undergo individual evaluation to assess prognosis and risks. Such evaluations take into consideration the type of cancer, its stage, and the organs involved. The combination of standard procedures with regional chemotherapy offers an option when systemic approach is not showing the expected results.