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Mon 19 Jan 2009 04:00 AM

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A gentler kind of chemo

A pioneer of regional chemotherapy, Dr Karl Aigner has made it his mission to lengthen lives and reduce the torturous side effects of "chemo".

A pioneer of regional chemotherapy, Dr Karl Aigner has made it his mission to lengthen lives and reduce the torturous side effects of "chemo".

Many of us would imagine that the last 29 years would have provided the world with some incredible new drug or discovery to reduce deaths from cancer. But shockingly, they haven't.

These words, from Der Spiegel magazine - Europe‘s largest weekly magazine - in 2004, would chill the heart of any newly diagnosed cancer patient. "Although survival times and life expectancy [for breast, lung, intestine and prostate cancer] have not changed in 25 years, the cost of drugs and therapies have increased tremendously - from some $6 to $16 billion within eight years."

If I had known about regional chemotherapy in 2002 I would have chosen it. - Sharon Evans, breast cancer survivor.

And one of the most expensive ways to treat cancer - in terms of physical side effects as well as cost - is chemotherapy. So what is it and why is it used?

Demystifying chemotherapy

The war on cancer in conventional medicine is pretty much a desperate onslaught. Doctors take chemical concoctions that are known to be highly poisonous and literally pour them into a patient's body, with full recognition that this will kill many of the patient's healthy cells as well as their cancerous ones. Chemotherapy is usually employed as a last resort, after surgery or radiotherapy has proven to be futile. It has never been presented as a cure - merely the promise of postponement.

In most cases, according to research, it does not even postpone death. A study published in the journal Clinical Oncology in 2004 reported that chemotherapy has an average 5-year survival success rate of just over 2% for all cancers. Most commonly, it is a means to "do something" when most hope has vanished or is rapidly disappearing over the horizon.

Dr Tullio Simoncini, an Italian oncologist, says: "Chemotherapy, in fact, destroys everything. It is a given fact that it dramatically exhausts the cells of the marrow and of the blood, thus allowing a greater spreading of the infection. It irreversibly intoxicates the liver, thus preventing it from building new elements of defence, and it mercilessly knocks out nerve cells, thus weakening the organism's reactive capabilities and delivering it to the invaders.

Dr John Cairns, professor of microbiology at Harvard University School of Public Health from 1980 to 1991, published a 1985 critique in the journal Scientific American, stating: "Aside from certain rare cancers, it is not possible to detect any sudden changes in the death rates for any of the major cancers that could be credited to chemotherapy. Whether any of the common cancers can be cured by chemotherapy has yet to be established."

So, in reality, chemotherapy is not a hopeful therapy. It is crisis treatment in the face of fear.

That said, there is a place for it in cancer treatment. When patients are in the early stages of cancer (stage 1 and 2) doctors prefer to use hormone therapy or radiotherapy to treat patients.

But when a patient is in stage 3 or 4, their cancer is deemed severe enough to warrant a toxic onslaught. At this stage, the odds of survival are very small, and oncologists and relatives alike are keen to try one more weapon on the ''battlefield", even if only to win a few more months of life for the cancer sufferer.

On this battlefield there are two types of chemo "weapon" - systemic and regional chemotherapy. What is the difference and is there a greater benefit with the latter?

Systemic vs regional chemo

Systemic chemotherapy involves giving the whole patient's body a large dose of toxic drugs that are capable of killing both healthy and cancerous cells. Systemic implies "the entire system"- the whole body.

During regional chemotherapy, on the other hand, the oncologist isolates the part of the body where the cancer has been detected and only treats this part with toxic drugs.

The drugs are sent through the artery that feeds blood directly to the tumour. In this way the surgeon is able to limit the side effects of chemo to the diseased area, and not harm the patient's entire body. Studies show that not only do less side effects occur from this method of chemotherapy, but patients live a bit longer too.

So, considering the fact that regional chemotherapy is remarkably less poisonous in its overall effect on the body than systemic and helps patients live a bit longer, why is it so rarely used?

As a pioneer of regional chemotherapy for more than 25 years, professor and surgical oncologist, Karl Aigner, medical director of Medias Klinikum, at Dubai Healthcare City and Burghausen, Germany, is baffled by the popularity of systemic chemotherapy. Based on the results of his own work he can see a clear case for promoting regional chemo in cases of locally advanced cancer (cancer that has spread from where it began to nearby tissue or lymph nodes).

Granted, he understands that one factor affecting the popularity of regional chemo is that it requires specialised surgical skills, and there aren't many surgeons trained in this specialty around the world.

Nevertheless, he believes that the results are incentive enough for more doctors to train in this specialty. Besides, the actual training is not that difficult, he says, having trained doctors at his clinic, MediasKlinikum, in Germany. As a heart, thoracic, vascular and orthopaedic surgeon, Dr Aigner has the insight essential to be a good teacher, but he acknowledges that his students' success rate rests in the quality of their hands.

"It's all in the hands," he says. "For example, I trained a Hamburg doctor to perform regional chemotherapy but he did not achieve the same results I did. On the other hand, I trained a Middle Eastern surgical oncologist, who matched my results. Italian doctors tend to learn the technique very well, too." Decades of experience

Dr Aigner has performed regional chemotherapy on many different types of cancers and reported his success rates in several medical journals. Because breast cancer rates in the UAE are notoriously high it seems fitting that his expertise is now based in Dubai several times a month, tending to local patients.

He has been operating on breast cacncer patients since 1986, averaging around 40 cases per year. At minimum he has worked on 700 cases since 1986.

He states: "In 26% of cases - this is every fourth woman being treated with regional chemotherapy - a complete remission of the cancerous lesions could be achieved without any local surgery."

He adds, "The local recurrence rate of 17% after 16 years follow-up was very low, and patients did not suffer the side effects of normal (systemic) chemotherapy and were able to work during the treatment. Hair loss, if ever, mostly was moderate and normally did not occur."

Benefits of regional chemo in breast cancer

According to Dr Aigner, when regional chemotherapy is used in cases of breast cancer:

• Amputation can be avoided almost always

• 2/3 of all patients can expect tumour shrinkage of more than 50%

• 25% of patients can expect complete remission iwithin three cycles

• There are few side effects - less than 5% of patients experience hair loss

• Skin inflammation occurs in only 4% of patients

• Patients feel well enough to work between bouts of chemo

• There has been a recurrence rate of only 17% over 16 years.

Dr Aigner's results are on record in several highly respected cancer journals. The most recent studies were published in 2008.

One study, published in the April issue of Cancer Therapy reported that a specific regional chemotherapy technique, called "isolated hypoxic abdominal perfusion", resulted in increased survival for patients with platin-refractory recurrent ovarian cancer. Dr Aigner explains that the technique is not new - just underutilised. He and his colleagues have been performing it for nearly 30 years, with a high success rate and almost no side effects.

In another study, published in the February issue of Cancer Therapy, Dr Aigner administered regional chemo to 53 breast cancer patients with positive results. Patients reported that their quality of life was generally good, and most were able to continue working between treatment cycles.

On the cancer battleground, this is no minor matter. For patients to be able to resume normal life, with few side effects between treatments, offers a chance to grab at life and hold on. Dr Aigner's treatment offers hope, without which there is no point in going into battle.

As the famous sportsman and cancer survivor, Lance Armstrong, said: "When you think about it, what other choice is there but to hope? We have two options, medically and emotionally: give up, or fight like hell."

Regional chemo offers greater reason to fight.


Dr Karl Aigner: tel +49 (0) 8677 / 9160-0, www.medias-klinikum.de, www.prof-aigner.de

View several video testimonials from Dr Aigner's patients at www.youtube.com/user/MediasKlinikum

A cancer survivor’s storySharon Evans, a registered ICU nurse who works at Dubai Healthcare City's Centre for Planning and Quality Control, is a breast cancer survivor. Despite her knowledge of chemotherapy's traumatic effects on the body, she chose to embrace it wholeheartedly. When asked why, she says: "Cancer is a rapidly growing disease. It was going to kill me if I didn't do something about it. I also knew that chemotherapy attacks rapidly growing cells."

She adds, "With my nursing experience I've seen lots of people die after having chemo. I've seen lots of people live... one person I know is a 12-year survivor after having chemo. ... I just thought ‘I'm young and I can beat this.' I just wanted everything thrown at me so that I could use it."

In 2002 Evans was diagnosed with the severest grade of cancer - grade_3. But luckily it was in the early phase - stage 1. At the time she was offered radiotherapy and systemmic chemotherapy, but no one ever mentioned regional chemotherapy.

Today Evans says, "If I had known about regional chemotherapy in 2002 I would have chosen it."

Although she believes chemotherapy beat her cancer, she suffered tremendous side effects, such as:

• Losing all her hair after 2.5 weeks

• Continual motion sickness

• Daily nausea and vomiting

• Entering premature menopause.

Evans is a rare survivor, but she puts it down to her strong fighting spirit. For cancer patients faced with the choice of chemotherapy she offers the following words of advice: "Trust your own judgement. Listen to the professionals and then decide what treatment is best for you."

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