Chemembolization and Radioembolization Treatment

Interventional radiology, a rapidly advancing branch of medicine, is the therapeutic section of radiology. In interventional radiology, treatments defined within the group of minimally invasive surgical methods either serve as a surgical alternative or are offered as treatment options when surgery is not feasible.

What is Chemembolization?

In interventional radiology, the medication is administered through the vein, and because it is at a concentration 100 times greater, it kills tumor cells much more effectively. There are many methods in interventional radiology, but generally speaking about embolization; embolization includes treatments that reach the relevant organ through the blood vessel. Essentially, embolization means the occlusion of the vessel. The vessel gets blocked, and diseased vessels are closed, but it’s not that simple. While blocking the vessels in tumors, it ensures that the chemotherapeutic drug is trapped inside the tumor at a concentration approximately 100 times higher than that administered via the normal systemic route, i.e., through the veins. Thus, the chemotherapeutic drug can kill tumor cells in the tumor bed much more effectively at a concentration 100 times higher, and since it is not involved in the general circulation and is only trapped in the tumor bed, the systemic effects on the patient are minimal. Systemic effects, such as nausea, vomiting, gastrointestinal symptoms, neurological symptoms, and hair loss experienced by the patient after chemotherapy, are either absent or very minimal in these treatments. The underlying philosophy of the treatment's success is to cause minimal harm to patients and to minimally disrupt tissue integrity

In Which Diseases is Chemembolization Applied?

Embolization performed with chemotherapy is referred to as "chemembolization." The chemembolization method is applied to cancerous organs, with the liver being the primary focus. In fact, this method can be used in many organs, but currently, the organ with the most extensive evidence of the effects of these treatments is the liver. The liver is also the most critical organ in cancer diseases because it is the area where cancer most frequently metastasizes. Therefore, in advanced stages, liver metastases become the most common cause of death in cancers and determine the patient's lifespan. Consequently, chemembolization is applied for liver tumors. It is applied not only for metastases that have spread to the liver but also for tumors that originate directly from the liver.

When is Chemembolization Applied?

In medicine, there are always algorithms, meaning sequences. These sequences are established considering the situations where the patient will benefit the most. In cases of tumors originating from the liver's own tissue and tumors metastasizing to the liver, if surgical removal can be performed, it prolongs the patient’s life. This has also been scientifically proven. However, this is not the case for all metastases. Here, particularly for metastases originating from the gastrointestinal system, we have this data. For some of the other metastases, as the level of evidence in studies on this topic increases, this information also grows.

If removing the tumor in the liver prolongs the patient's life, but the size, location, and status of the tumor hinder surgery, chemembolization comes into play. What is done here actually aligns with surgical logic.

Does Chemembolization Extend Lifespan?

For example, in metastases originating from the gastrointestinal system that have spread to the liver, nearly 30% of patients, or one-third, have a metastatic finding at the time the disease is diagnosed. The surgical removal of metastases in the liver extends the patient's lifespan. All of this information comes from statistical data accumulated over the years. However, only 15-20% of patients are suitable for surgical removal of metastases from the liver. This means that a large majority of patients are not suitable for surgical removal of liver metastases. In this case, chemembolization, a method referred to as minimal surgery, can come into play. Currently, there are revolutionary advancements in oncology, achieving great success with chemotherapy drugs. However, according to general statistics, in patients resistant to chemotherapeutic treatments, the chemembolization method increases lifespan by 20%.

What is the Procedure and How Long Does It Take?

This procedure is essentially an angiographic procedure. A catheter is inserted through the groin or sometimes through the arm to reach the liver's blood vessels. Once the liver's blood vessels are reached, smaller tubes are used to access the vessels supplying blood to the liver, and occlusive materials are injected into those vessels. Depending on the patient's condition, this procedure takes approximately one hour.

Are There Side Effects?

With advancements in technology, patients now stay in the hospital for only one day. After the embolization, patients may experience pain, fever, and nausea. These symptoms develop rapidly within the first 24 hours, and a mild flu-like weakness may persist for about one week to ten days. However, these side effects are significantly less than those experienced with chemotherapy treatment

What is the Success Rate?

The success rate of cancer treatments with this method is also increasing. Techniques and methods are evolving, and new drugs are being introduced. This not only increases success but also leads to the use of this method alongside other chemotherapeutic drugs, progressing with the development of new techniques and treatments, just like with other medications.

What is Radioembolization?

Radioembolization is also a method applied via the vascular route. Here, a radiotherapeutic agent is injected into the tumor. In a sense, “radiotherapy” is applied inside the body. Radiation particles, or small particles emitting radiation, are introduced into the tumor by entering the body. The advantage of this method over externally administered radiotherapy is that it targets only a limited area of the liver, applying treatment directly to the tumor. External radiation can potentially damage neighboring tissues. By entering through the blood vessel and using the embolization method, radiation-emitting particles are delivered to the tumor bed.

Radioembolization can be applied not only for liver cancer but also for lung tumors, for example. It can also be performed in kidney tumors, particularly in cases of excessive bleeding.