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​Regional therapies

About regional therapies

Regional therapies, also called organ-directed therapies, are a targeted treatment approach that allows doctors to deliver high doses of chemotherapy or radiation directly to the tumor, while sparing the rest of the body to harmful levels of toxicity. The treatments are strategic in choosing a specific target, rather than being delivered throughout the body. The types of regional therapies we use to treat cancer include:

Hyperthermic intraperitoneal chemotherapy (HIPEC)

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a highly concentrated, heated chemotherapy treatment delivered directly to the abdomen during surgery.

Unlike systemic chemotherapy delivery, which circulates throughout the body via the bloodstream, HIPEC delivers chemotherapy directly to cancer cells in the abdomen. This allows for higher doses of chemotherapy treatment. Heating the solution may also improve the absorption of chemotherapy drugs by tumors and destroy microscopic cancer cells that remain in the abdomen after surgery.

Before patients receive HIPEC treatment, doctors perform cytoreductive surgery—a procedure to debulk, or reduce, the size of a cancerous tumor—within the abdomen. When as many tumors as possible have been removed, a heated, sterilized chemotherapy solution is delivered to the abdomen to penetrate and destroy remaining cancer cells. The solution is 41 to 42 degrees Celsius, about the temperature of a warm bath. It’s circulated throughout the abdomen for approximately 90 minutes. The solution is then drained from the abdomen, and the incision is closed.

HIPEC is a treatment option for people who have advanced surface spread of cancer within the abdomen, but no cancer outside the abdomen.

HIPEC:

Chemoembolization

Chemoembolization is an interventional radiology procedure designed to reduce blood supply to a tumor and deliver chemotherapy drugs directly to the tumor while reducing exposure to healthy tissues. This procedure reduces the side effects of chemotherapy while killing cancer cells.

Chemoembolization allows chemotherapy drugs to directly target the cancerous tissue, in a higher concentration, for a longer period of time, reducing the body’s exposure to the drugs.

This method of chemotherapy is primarily used to treat liver cancer, and may also be used to treat cancers that have spread to the liver.

During chemoembolization, an interventional radiologist inserts a catheter into an artery and guides the catheter to the tumors in the liver. Chemotherapy is directly delivered into a tumor, through a catheter, using image guidance. The chemotherapy drugs are released into the tumor, blocking the flow of blood to the tumor.

Intra-arterial chemotherapy (IAC)

Intra-arterial chemotherapy (IAC) delivers chemotherapy drugs directly to a tumor, while reducing exposure to healthy tissues. This delivery method also helps to reduce side effects, like nausea and vomiting, and enhance the drugs’ cancer-killing properties.

During IAC, a thin catheter is threaded through the femoral artery in the right leg. Using image guidance, chemotherapy is injected directly into the hepatic artery, which is the main blood vessel that delivers blood to the liver.

IAC allows high doses of chemotherapy drugs to be targeted directly to the cancerous tissue for a longer period of time, without exposing the body to the effect of the drugs.

Like chemoembolization, this method of chemotherapy is primarily used to treat liver cancer, but may also be used to treat cancers that have spread to the liver.

Intraperitoneal chemotherapy

Intraperitoneal chemotherapy is often a treatment for ovarian cancer, which often spreads into the abdominal cavity. This chemotherapy technique delivers chemotherapy drugs directly into the abdominal cavity through a catheter (thin tube).

The catheter may be placed during staging surgery. If it is not inserted at that time, it may be placed during a laparoscopic procedure. The catheter may be connected to a port, which is a small, quarter-sized disc that sits just under the skin and connects to a large vein. Chemotherapy medicines are administered through a special needle that fits into the port. Blood may also be drawn through the port, saving a patient multiple needle sticks.

Intraperitoneal chemotherapy directly targets cancer cells in the abdomen, helping to reduce drug exposure to healthy tissues. Intraperitoneal chemotherapy provides a concentrated dose of drugs to the cancer cells in the abdominal cavity. The chemotherapy is also absorbed into the bloodstream, reaching cancer cells outside the abdomen. Higher doses of chemotherapy drugs may be administered intraperitoneally, or directly into a body cavity, instead of intravenously, or into a vein.

Intraperitoneal chemotherapy may be a treatment option for women with ovarian cancer that has spread inside the abdomen. Candidates for intraperitoneal chemotherapy typically cannot have a large amount of scar tissue inside the abdomen because it may prevent the medication from reaching the necessary areas. Women must also have normal kidney function and be in good overall health to be considered for the treatment.

HIPEC, explained above, is another form of this treatment.

Intrathecal chemotherapy

Intrathecal chemotherapy may be used to treat cancers that have reached the central nervous system, including some types of leukemia and lymphoma.

Typically, chemotherapy drugs do not pass through the blood-brain barrier. This chemotherapy technique delivers chemotherapy drugs directly into the cerebrospinal fluid surrounding the brain and spinal cord to target cancer cells that have spread there.

Intrathecal chemotherapy is delivered through a lumbar puncture (spinal tap) or a device placed under the scalp. Patients typically need to lie flat after the treatment to allow the chemotherapy to reach all areas of the spinal cord and brain.