LIVER CANCER TREATMENT IN GERMANY

SURGICAL TREATMENT

Surgery is the most effective method of treating liver cancer. The range of liver operations varies with the clinical picture — from placing stents in the bile ducts to relieve the symptoms of jaundice, to laparoscopic atypical liver resections and highly complex procedures such as extended hemihepatectomy (removal of 2/3 of the liver). Operations are performed using every modern technology available, including measures to prevent bleeding and bile leakage.

Hepatology departments provide both radical and palliative treatment of liver cancer:

• radical: laparoscopic liver resections, in particular hemihepatectomy (removal of a lobe of the liver) and extended hemihepatectomy (removal of up to 2/3 of the liver);

• palliative: ERCP (endoscopic retrograde cholangiopancreatography) with the placement of stents in the bile ducts where the tumour obstructs the outflow of bile.

An advantage of surgical treatment is the use of the most advanced technologies, such as high-frequency coagulation, ultrasonic dissection and the latest means of preventing bleeding and bile leakage.

Patients for whom surgery or liver transplantation is not indicated are offered local non-surgical ways of treating the tumour, e.g. transarterial chemoembolisation or radiotherapy, as well as systemic therapy. If an operation is not possible, the tumour can still be reduced in size or its growth slowed down. Where there are 1-3 lesions in the liver, a local technique such as radiofrequency thermal ablation may be used in some cases. During this procedure a needle electrode is placed directly into the tumour; it delivers radiofrequency energy and briefly heats the tumour to a high temperature, thereby destroying both cancerous and healthy cells.

CHEMOEMBOLISATION

In chemoembolisation (the TACE technique) the drug is introduced through a small puncture in the femoral artery directly into the vessel that supplies the tumour with blood. At the same time the vessels feeding the tumour are filled with an embolising agent. The aim of the therapy is to halt the growth of the tumour and reduce its size. In a number of cases the TACE technique is so effective that the tumour shrinks to a size that allows it to be removed surgically. The procedure itself is performed by a surgeon in an angiography suite. Chemoembolisation may be carried out on its own or in combination with other treatment methods.

RADIOTHERAPY FOR LIVER CANCER

In some cases selective internal radiation therapy (SIRT) is used: microscopic particles are introduced into an artery and create high-level local internal irradiation inside the blood vessels of the tumour.

Liver cancer may be treated with SBRT stereotactic radiosurgery (a modern form of radiotherapy using high single doses over 3-5 sessions) or with conventionally fractionated radiotherapy (30 sessions), both for primary tumours (hepatocellular carcinoma and cholangiocarcinoma) and for liver metastases in patients with inoperable liver cancer. External beam radiotherapy is used mainly when the spread of the tumour causes the patient pain. The use of radiotherapy is limited by the fact that healthy liver tissue is very sensitive to this kind of exposure.

SBRT and conventionally fractionated radiotherapy are non-invasive treatments for liver tumours that are well tolerated by patients and have minimal side effects. Where pain is severe, radiotherapy also serves a palliative purpose.

DRUG TREATMENT OF LIVER CANCER

The only drug therapy known to prolong a patient's life is treatment with sorafenib, an anti-tumour drug that acts on specific molecular targets (so-called targeted therapy). It is prescribed in cases where the cancer has already spread widely and does not respond to local treatment (surgery, radiofrequency thermal ablation or embolisation). New drug treatments are currently under investigation.

ADVANTAGES OF LIVER CANCER TREATMENT IN GERMANY

• rapid arrangement of an appointment with leading German hepatology experts;

• diagnostics and treatment exclusively at certified university oncology centres;

• selection of the optimal individual therapy: the treatment approach for each patient is decided by an interdisciplinary tumour board involving hepatologist-oncologists, surgeons, chemotherapists, radiologists, pathologists and radiation oncologists;

• innovative diagnostic techniques: CT, MRI, FDG-PET/CT;

• biopsy under ultrasound, CT and MRI guidance;

• precise pathological diagnosis at certified institutes of pathology;

• treatment started without delay once the diagnostic work-up is complete;

• adherence to the international treatment protocols recommended by the European Society for Medical Oncology (ESMO) and the German Cancer Society (DKG);

• the full range of radical and palliative operations for liver cancer (surgical oncologists specialising in liver tumour surgery);

• targeted therapy of liver cancer with sorafenib;

• radiosurgery for primary liver cancer and liver metastases – treating the tumour with a focused, high-intensity beam of radiation;

• the highest quality standards in medical care;

• early postoperative rehabilitation of patients;

• the use of minimally invasive surgical techniques wherever possible;

• implantation of a port system for chemotherapy to avoid damage to the peripheral veins;

• supportive therapy to minimise the side effects of chemotherapy and radiotherapy.