One more weapon in the cancer arsenal

BERLIN WOMAN Franziska Springer’s battle with breast cancer lay two years in the past when, in 2010, the bad news came.

She was still on chemotherapy tablets and having regular blood transfusions to hold her condition in check. But the 39-year-old civil servant had returned to work, was exercising regularly and felt like her old self.

Then a regular check-up showed something was wrong with her blood test results. Further tests confirmed her oncologist’s suspicions: she had a tumour on her liver.

“It all felt unreal and abstract because I honestly felt nothing and after surgery, chemo and radiotherapy for the breast cancer, I felt fine again,” she says. “As soon as I heard the diagnosis I just wanted them to cut it out of me immediately.”

She was diagnosed with liver metastasis resulting from her breast cancer. Fewer than 20 per cent of such tumours are operable, either because of their size or because of their location.

Traditional radiotherapy is one treatment option but brings its own risks, such as radiation-induced liver disease. It is not considered effective in tackling tumours beyond three or four centimetres in diametre.

A liver metastasis discovered too late and in the wrong location could mean a dim prognosis for the patient. But not any more – thanks to a therapy in Berlin to treat liver tumours and metastasis using targeted, high-dose internal radiotherapy (brachytherapy).

The therapy, developed at Berlin’s Charité university clinic, is particularly effective on tumours greater than 7cm in diametre, for which no other effective procedure exists.

“We can tackle almost any tumour size with this procedure, the energy goes directly into the tumour,” says Dr Bernhard Gebauer, associate professor of the Charité radiology department.

The procedure is simple enough: through a small puncture surgeons insert a hollow catheter tube, thinner than a straw, to the site of the tumour.

At the liver the surgeon presses inside the growth; inside the catheter tube, another tube carries the radiation dose directly to where it is needed.

The targeted nature of the treatment means doctors can use a high radiation dose without worrying about extraneous damage to the rest of the liver, neighbouring organs or skin. The entire operation is minimally invasive and usually performed under local anaesthetic.

“Patients find the procedure very tolerable: there is sometimes a little sickness or pain afterwards but they are usually out of hospital after two or three nights,” says Gebauer.

The treatment is primarily used for cases of liver cancer but the Berlin doctor has used it also to combat effectively tumours elsewhere, from lungs to lymph nodes.

The Charité clinic began working on the procedure a decade ago; today a normal treatment day involves three or four patients, with local control rate of the tumours of over 85 per cent.

The clinic has published its first limited study of 35 patients with liver cancer – men and women aged 29-82 – treated over a two-year period for tumours with an average diameter of 7cm. One treatment session was sufficient for all but three cases: these cases involved very large tumours and required a second session to tackle local tumour progressions.

In all 35 patients, a six-week check-up revealed the tumour had been neutralised with 100 per cent success. Further check-ups showed recurrences in nine of the 35 cases, which were also effectively treated.

After 15 months, all patients had completed their treatment. The Berlin doctors are confident their procedure can be used for tumours up to 12 cm in diameter and are happy to take treatment inquiries from abroad.

Franziska Springer says her oncologist was less than enthused by her request for the procedure. He reminded her that the internal radiotherapy tackled only a symptom of her condition and not the underlying cause: the cancerous cells which, then as now, remain in her system and which she continues to fight with chemotherapy tablets and transfusions.

“But I still think it is important to have this option. With cancer in particular, I think the psyche plays an important role alongside the physical,” she says. “I know the malignant cells are still there, but they’re not building up in my liver any more.”

She recovered from surgery within two days. The tiny entry point on her abdomen was so discreet, she says, that the surgery felt as abstract as the tumour itself.

Later that month she was holidaying with her family as planned on the Baltic Sea. Her battle with cancer continues but, thanks to Berlin’s Charité clinic, she has added one more weapon to her arsenal.

radiologie.charite.de/

Email: minimal-invasive-ambulanz@charite.de