Evolving of much safer and targeted intra-arterial treatment called drug eluting bead chemo embolisation, also known as DEB-TACE, more and more patients are opting for this revolutionary method to treat hepatocellular carcinoma (HCC).
Itis a primary liver cancer, which means it originates in liver and is not because of cancer spread and is the sixth commonest cancer and the third largest cause of cancer deaths in the world. Treatment of this lethal disease has always been painful, expensive and time consuming.
Trysacryl speheres and hydrogel spheres made from polyvinyl alcohol are the two types of drug eluting beads available and essentially both work on the same principle. The beads are like “Sago” (Sabudana) seeds that absorb chemotherapy drug called doxorubicin and are released directly in the blood stream into the blood circulation that goes inside the primary liver cancer tumour. They get distributed in capillaries in the entire tumour thus the blood flow to this circulation is blocked by these spheres and they stay inside the tumour and release a very high concentration of chemotherapy drug that kills the tumour cells.
Speaking about this treatment, Dr. Sandip Jhala, Interventional Specialist, Apollo Hospitals-Ahmedabad said “The reason why drug eluting bead chemo-embolisation is fast becoming the most acceptable line of treatment is because these beads have been shown in several studies to effectively destroy the tumour and very little drug goes into circulating blood stream. This is why patients do not experience any side effects and has a higher survival rate compared to C-TACE even in presence of advanced disease or mild to moderate cirrhosis known as Child Class A and B cirrhosis.”
Similar to this is radioactive glass beads carrying radioactive substance Yittrium=90 when released into blood circulation give radiotherapy locally to tumour cells (called radio embolisation) and is very helpful in advanced primary liver cancers as it is far too expensive and has less safe margin for its routine use.
At Apollo Hospitals, Ahmedabad approximately 75 tumours have been successfully embolised with DEB Bead Chemo-embolisation with patients tolerating the treatment very well even at the age of 82 years. Most patients have to be hospitalized for 3-4 days and procedure is done on the first day which takes about one and a half hour of time. They are able to walk about and eat after six hours. The term cure is not used except in surgery for this cancer and so all other treatment modalities are considered as effective palliation when cancer cannot be surgically resected.
Presence of cirrhosis rules out surgery. Less than one third of all liver cancers only can be treated with surgical resection, ablation or transplantation. DEB bead chemo embolisation because of not having any side effects that occur with conventional chemotherapy is best suited option in this scenario and can be done for patients awaiting liver transplant.
Drug-eluting beads (DEBs) and radio embolisation procedures are applicable in the treatment of primary and metastatic liver cancer among patients who do not qualify for surgical resection of the tumour. Most patients with primary liver cancer have little or no symptoms and by the time they are detected, they are not candidates for surgery or ablation, said Dr. Sandip Jhala.
Primary Liver cancer is known to be caused by Hepatitis B and Hepatitis C virus infections as a long term sequel and also by Aflatoxin a fungal toxin found in groundnuts. Cirrhosis of liver due to alcohol abuse and fatty liver caused by faulty high fat containing fast foods, long term medication and diabetes which are major causes increase in cases of primary liver cancer seen today. Though treatment options like Surgery, Tumor ablation (destruction by radiofrequency heat and microwave heat) and Conventional Intra Arterial injection of chemotherapy called C-TACE are still available, most of the patients are increasingly opting for DEB bead chemo embolisation.