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Tumor assault extends liver cancer survival
Source: (cancerfacts.com)
Thursday, December 01, 2005
ANN ARBOR, Mich. – Dec. 1, 2005 – Directing radiation precisely to liver tumors that can't be surgically removed followed by huge amounts of chemotherapy injected directly into the tumor has resulted in significantly longer survival, researchers say.
In a study reported in today's Journal of Clinical Oncology, researchers led by Dr. Edgar Ben-Josef, associate professor of radiation oncology at the University of Michigan Medical School, showed that such an all-out assault on liver tumors produced a median survival of 15.8 months, which is nearly double the historical median survival of these patients.
The treatment is aimed at patients whose tumor is growing in a way that it can't be removed, leaving them with few options.
"The patients with metastatic colorectal cancer who were entered in this trial, for example, were for the most part out of chemotherapy options at the time of referral," Ben-Josef said in a prepared statement. "These are patients that we estimate would have had a life expectancy of nine, maybe 12 months. They also did not have any surgical or other local treatment options. So a median survival of 17 months in such patients is quite a substantial improvement and definitely clinically relevant."
The researchers looked specifically at patients with bile duct cancer, liver cancer or colon cancer that had spread to the liver, all of whom were not candidates for surgery. Typical survival rates for these cancers are eight or nine months. In this study, liver cancer patients lived an average 15.2 months, bile duct cancer patients lived 13.3 months and colon cancer patients lived 17.2 months.
In the study, patients received radiation twice daily for two weeks, along with a continuous infusion of the chemotherapy drug floxuridine. The patients then had a two-week break before repeating the radiation and chemotherapy regimen for another two weeks. The chemotherapy was delivered through a catheter into the artery that directly feeds the liver.
The treatment approach was developed at the University of Michigan by Drs. Theodore Lawrence, and Isadore Lampe. The National Institutes of Health funded the study.
Traditionally, radiation therapy has not been effective against liver cancer because the liver is too sensitive to receive radiation. Instead of treating the entire liver, however, the researchers theorized they could focus the radiation on only the tumor. The radiation oncologists designed a treatment that directly targets the tumor, using conformal radiation techniques that precisely deliver pinpoint radiation beams. This allows a higher dose of radiation to be used and spares as much of the normal liver tissue as possible.
As a result, less than a third of the patients in the study experienced severe complications from the treatment. The most common severe problems were upper gastrointestinal ulcers or bleeding, liver disease from the radiation, and problems from the catheter.
The chemotherapy delivery takes advantage of the liver having two major blood supplies but needing only one. The tumor lives off one of the two blood supplies, and the artery feeding into the liver actually feeds the tumor's growth. With the treatment used in this study, the chemotherapy is infused directly into this artery so the drug goes directly to the tumors in the liver.
The liver is also where chemotherapy drugs are typically processed and removed from the blood supply. By targeting the drugs to the liver, very little of the drug travels throughout the body, allowing researchers to deliver a higher dose.
Most often, liver tumors originate as cancer in another part of the body and spread to the liver. Primary liver cancer, or cancer that starts in the liver, is among the most serious and deadly types of cancer. Typically, it's not discovered until an advanced stage because it causes few distinct symptoms. About 17,500 people are expected to be diagnosed with primary liver cancer or bile duct cancer this year, and 15,420 will die from it, according to the American Cancer Society.
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