idw – Informationsdienst Wissenschaft
Nachrichten, Termine, Experten
Nachrichten, Termine, Experten
idw - Informationsdienst
Wissenschaft
Chemotherapy drugs are administered via a port system in the abdominal cavity. The MHH is one of the first clinics in Germany to establish this method.
Patients with tumors on the peritoneum have little chance of recovery, as these are usually metastases from a tumor in another abdominal organ, such as the stomach. When peritoneal metastases are diagnosed, the cancer is often already at an advanced stage and treatment is difficult. An MHH team consisting of specialists from the Department of General, Visceral, and Transplant Surgery and the Department of Gastroenterology, Hepatology, Infectiology, and Endocrinology is now offering a new treatment method. It is called NIPS (neoadjuvant intraperitoneal systemic therapy). It combines conventional chemotherapy administered intravenously with targeted chemotherapy in the abdominal cavity. The goal is to shrink the primary tumor and metastases so that they can then be removed surgically. The new therapy is intended for certain palliative patients with stomach cancer and metastases in the peritoneum. For them, there is hope for a significantly longer survival time.
No effective therapies to date
Stomach cancer is one of the ten most common types of cancer. In Germany, around 14,500 people are diagnosed with it every year. More than one in three of those affected develop peritoneal metastases, also known as abdominal metastases, in the advanced stages. The peritoneum is a thin layer of connective tissue that lines the abdominal cavity. “Unlike metastases in other organs, such as the liver or lungs, there are currently no effective treatment options for metastases in the peritoneum,” explains senior physician and private lecturer Dr. Thomas Wirth from the Department of Gastroenterology, Hepatology, Infectiology, and Endocrinology. The standard treatment for these patients is palliative systemic chemotherapy with an average survival time of six to twelve months.
Surgical options only in a few cases
The surgical options are also very limited, especially since only a few patients are suitable for them. One of these is cytoreduction and HIPEC (hyperthermic intraperitoneal chemotherapy). "Cytoreduction means that the gastric carcinoma and the peritoneal metastases are first removed surgically. Immediately afterwards, the abdominal cavity is flushed with a heated chemotherapeutic agent to kill scattered tumor cells and delay the recurrence of new tumors," explains Professor Beate Rau, Head of Special Oncological Surgery at the Clinic for General, Visceral, and Transplant Surgery. The second option is called PIPAC (Pressurized Intraperitoneal Aerosolized Chemotherapy). “In this method, chemotherapy is sprayed into the abdominal cavity and onto the metastases using a pressure technique – similar to hairspray – via laparoscopy, i.e., through two small incisions in the skin,” explains Professor Rau. PIPAC complements systemic chemotherapy and is administered alternately with it. Both methods, cytoreduction with HIPEC and PIPAC, require hospitalization.
Outpatient and simultaneous application
The new NIPS treatment method is a combination of systemic chemotherapy, which is administered intravenously and fights cancer cells throughout the body, and targeted chemotherapy, which is specifically aimed at peritoneal metastases. What makes it special is that a port is implanted under the skin in the abdomen to reach the tumors in the peritoneum. “The system consists of a small chamber with a membrane and a tube connected to it that leads into the abdominal cavity,” explains Professor Rau. The chemotherapy drug can then be administered through this port and distributed throughout the abdominal cavity. The procedure has many advantages. “We can perform it on an outpatient basis and at the same time as systemic chemotherapy,” explains PD Dr. Wirth. This means that patients do not have to be admitted to hospital and can complete both treatments in one go. Another advantage is that the same chemotherapy drug does not have to be used; the drugs can be individually combined for both applications.
First patients undergoing treatment
The two MHH clinics are jointly establishing the new NIPS treatment method. In addition to Professor Rau and PD Dr. Thomas Wirth, the team also includes gastroenterologist PD Dr. Anna Saborowski and surgeon Dr. Franziska Köhler. The MHH is one of the first clinics in Germany to implement the procedure. The team is already treating the first three patients. They receive the combined chemotherapy with NIPS once a week over a total period of nine weeks. After that, the specialists check whether the therapy has been successful and whether the stomach cancer and peritoneal metastases have shrunk enough to be surgically removed. PD Dr. Wirth is optimistic, citing a Japanese study. “Our colleagues in Japan are achieving truly remarkable success with NIPS, with some patients benefiting from a life extension of several years.” With NIPS, the team is expanding the range of therapies available and hopes to offer new opportunities to palliative patients with stomach cancer and metastases in the peritoneum. “NIPS is an additional palliative therapy with great potential,” states Professor Rau. However, patients must be carefully selected for this treatment method, as it is not suitable for everyone. The plan is to treat around ten patients per year using this method.
SERVICE
For further information, please contact Professor Dr. Beate Rau, rau.beate@mh-hannover.de, and Dr. Thomas Wirth, wirth.thomas@mh-hannover.de.
The chemotherapy drug is administered into the abdominal cavity via a port. The new treatment method ...
Copyright: Karin Kaiser/MHH.
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