Regional Chemotherapy (RCT) - Isolated Hypoxic Pelvic Perfusion (HPP) | Oncological Clinic Medias in Burghausen, Germany

Isolated Hypoxic Pelvic Perfusion (HPP) is a specialized and advanced cancer treatment method that involves isolating the blood supply to the pelvic area and administering high-dose chemotherapy directly to tumors located within this region. The aim of this technique is to maximize the local concentration of chemotherapy drugs while minimizing the exposure of healthy tissues to these drugs, thereby reducing systemic side effects often associated with traditional chemotherapy. This targeted approach is particularly effective for cancers confined to or recurring in the pelvic region, including cancers of the bladder, rectum, cervix, and certain types of sarcomas and metastases. The process of HPP begins with the surgical isolation of the pelvic circulation. This is typically achieved by placing a catheter into the iliac artery, which supplies blood to the lower abdominal organs and the pelvic region. The catheter is connected to a closed-loop circuit that enables the selective delivery of chemotherapy drugs directly to the tumor site. Once the blood supply to the pelvic area is isolated, the chemotherapy drugs, such as melphalan, cisplatin, or other agents, are infused through the catheter, flooding the tumor tissues with high concentrations of the drug. This localized infusion allows much higher doses of the chemotherapy drugs to be delivered compared to systemic intravenous administration, where the drugs would be diluted and distributed throughout the body. The key feature of Isolated Hypoxic Pelvic Perfusion is that it is performed under conditions of hypoxia—meaning low oxygen levels—within the pelvic tumors. Tumors often develop in areas with insufficient blood supply, resulting in hypoxic conditions. These hypoxic environments make certain types of cancer cells more susceptible to the cytotoxic effects of chemotherapy. In normal tissue, chemotherapy drugs are typically less effective in hypoxic conditions, as low oxygen levels can protect cancer cells from damage. However, by using HPP, chemotherapy is introduced directly to the tumor in a high-concentration dose, allowing the drugs to overcome this barrier. The hypoxic environment in the tumor can also enhance the activity of certain drugs, making them more effective in killing cancer cells. HPP offers several advantages over traditional chemotherapy. One of the most significant benefits is that the localized delivery of chemotherapy directly targets the cancerous tissues while minimizing the systemic exposure of the body to toxic drugs. This allows for a much higher dose of chemotherapy to be administered to the tumor with reduced side effects. Systemic chemotherapy is often limited by the body’s ability to tolerate the side effects of high-dose drugs, including damage to healthy cells in organs like the heart, liver, and kidneys, and general immune suppression. In contrast, HPP allows for aggressive treatment with fewer adverse effects on healthy tissues because the chemotherapy is confined to the pelvic region, reducing the risk of systemic toxicity. Another advantage of Isolated Hypoxic Pelvic Perfusion is the ability to treat tumors that are resistant to standard chemotherapy. Many pelvic cancers are difficult to treat using conventional systemic methods, especially when tumors have become resistant to traditional chemotherapy. The localized high-dose chemotherapy delivered by HPP can overcome this resistance by directly attacking the cancer cells with a much higher concentration of drugs than would be possible in systemic therapy. The procedure itself is typically performed in a hospital or specialized clinic under general anesthesia. The patient is carefully monitored throughout the process, which usually takes a few hours. The infusion of chemotherapy drugs is closely controlled, and the temperature and pressure of the circulating fluids are carefully managed to ensure optimal drug absorption. After the infusion, the catheter is removed, and the blood supply to the pelvic region is restored. Following the procedure, patients are carefully monitored for any immediate side effects or complications, such as infection or blood clots, and are typically hospitalized for observation for a period of time to ensure that the procedure was successful and to manage any side effects. Isolated Hypoxic Pelvic Perfusion is often used for patients with localized or recurrent pelvic cancers when other treatment options, such as surgery or radiation therapy, may not be feasible, effective, or appropriate. It is also used in cases where tumors have not responded well to conventional chemotherapy or have metastasized to the pelvic region. The technique can be used as a primary treatment or as an adjunct to other therapies, such as surgery or radiation, to improve the overall effectiveness of cancer treatment. In terms of tumor types that are amenable to HPP, the procedure is particularly beneficial for solid tumors that are confined to the pelvic region. This includes cancers of the bladder, rectum, cervix, ovarian cancer, uterine cancer, and other pelvic malignancies. It has also been shown to be effective for treating certain types of sarcomas and metastases, especially when these tumors have recurred after previous treatments or when they are not responding to standard systemic chemotherapy. While it is not suitable for all types of cancer, it offers an option for patients who have limited treatment options available. Additionally, the ability to repeat HPP treatments offers another advantage for patients who may experience relapse or who do not achieve full remission after the first round of therapy. The procedure can typically be repeated, with intervals between treatments to allow for recovery and to assess the effectiveness of the previous infusion. Generally, an interval of at least three weeks is recommended between treatments to minimize the risk of damage to surrounding tissues and to allow for proper monitoring of patient progress. Overall, Isolated Hypoxic Pelvic Perfusion is an innovative and highly effective treatment method that offers targeted chemotherapy delivery to tumors in the pelvic region, allowing for higher drug concentrations and reduced systemic toxicity. This advanced approach is particularly valuable for treating cancers that are resistant to conventional therapies or are located in difficult-to-reach areas, making it an important tool in the fight against cancer. The ability to deliver aggressive, localized chemotherapy with minimal side effects provides patients with a promising option when other treatment options are limited.