Treatment concepts need to be evaluated individually and should meet the unique needs of each patient. To offer the best possible treatment, it is necessary to perform the best possible diagnostic work-up. That means patients should receive radiological examinations, nuclear medical examinations and biopsies to correctly diagnose and grade disease severity.
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Work-up and individual patient management
When patients want to have a medical record review by our specialists arranged we will decide whether previously performed diagnostic examinations are sufficient or should be repeated. Cancer can grow rapidly and thus it is necessary to ground treatment decisions on most recent radiological imaging.
We aim to coordinate the interdisciplinary collaboration of specialists of different oncological fields to holistically treat patients with complex metastatic diseases. Moreover, we aim to organize and coordinate patients' treatment and care.
Main cancer treatments represent surgery, radiation therapy and chemotherapy.
The aim of surgery is to completely remove tumors and metastases. It is possible to remove up to 80% of the liver. However, liver function has to be normal what is being evaluated with specific tests. The risk of liver surgery in metastatic liver disease can be estimated.
Solid lung metastases can be removed using a minimal invasive (thoracoscopic) approach. Lymphatic metastases can also be removed by surgery. In any case, the individual risk benefit ratio needs to be considered. However, even in cases where a total removal of the metastatic tumor disease is impossible, surgery may be performed to relieve symptoms and remove as much of the cancerous tissue as possible as a part of an interdisciplinary concept.
Radiation therapy for cancer treatment uses high doses of radiation to reduce the tumor mass. Radiation therapies consist of specific regimens with repetitive applications to repetitively destroy cancer cells. Although radiation fields and radiation dosages are carefully selected, normal body cells will get damaged as well, also depending on the localization of the tumor/metastasis. Radiation can be applied intraoperatively (IORT) or via external beam radiation in order to treat larger areas of the body and more areas at the same time. This might be necessary when metastases are very big or when metastases occur at different sites in the body.
By means of stereotactic radiation therapy it is possible to treat small tumor masses, e.g. brain tumors.
The Cyberknife allows radiation beams to be applied to a very specific area, that gets marked before, so metastases in the lung can be addressed properly while the patient is breathing normally.
Ablative approaches (Radiology)
Ablative approaches allow the treatment of a tumor with a large direct dose of a physical trigger (e.g. radiation/heat). Radioactive substances in different forms can be placed directly into or very close to the tumor to highly selective damage tumor cells.
Common approaches for liver metastases are Radiofrequency ablation, Microwave ablation, Laser induced thermotherapy or Afterloading.
Radio-embolization | Chemo-embolization | Chemo-infusion | Chemo-perfusion of the liver via the liver arteries (Radiology/Nuclear medicine/Oncology)
Regional treatment of liver metastases that are graded as unresectable can be addressed using transarterial therapy methods, including hepatic arterial infusion, transarterial chemoembolization and selective internal radiation therapy. By means of this "minimal invasive" approach, a local control of strict intrahepatic processes can be obtained. Frequently such procedures are combined with laser-induced thermotherapy, microwave ablation and radiofrequency.
Chemotherapy | Biological therapy | Immunotherapy | "Targeted" Therapy | Radionucleotide Therapy | Radioreceptortherapy | PRRT (Oncology, Nuclear medicine)
In many cases drug therapies are necessary to treat metastatic disease by applying infusions to systematically destroy cancer cells and stop them from spreading. Moreover, systemic intravenous therapies may lessen side effects related to the metastatic disease.
- Chemotherapy (also called "chemo") mostly combines different drugs to destroy cancer cells.
- Biological therapies help the patient's immune system to fight against cancer cells and neutralize them in the blood stream.
- Hormonal therapy changes the hormone levels in the blood and impair the growth of tumors that are dependent on hormonal growth induction.
- Targeted therapies allow a specific therapy against unique molecules in cancer cells to prevent them from growing and spreading.