The Comprehensive Cancer Centre of ‘Heart and Brain’ is the only member of the European Organisation of Cancer Institutes in Bulgaria

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In just three years, the centre has managed to establish itself as the preferred choice among thousands of patients

Around 3 million Europeans hear the diagnosis of cancer every year. More than half suffer from breast, colon, lung or prostate cancer or malignant haematological diseases. And although cancer is the second most common cause of death in the EU, up to 40% of cases are curable. 4 February is World Cancer Day and it is an occasion to remind people that early detection, prevention and quality care can save thousands of lives.

Oncologists and cancer specialists agree that innovation at all stages, from diagnosis and treatment to patient follow-up, is the cornerstone of successful therapy and improved quality of life. And at the heart of good outcomes is a comprehensive multidisciplinary approach.

Multidisciplinary treatment

Heart and Brain’s multidisciplinary teams include surgeons, pathologists, medical oncologists, clinical haematologists, radiotherapists, neurosurgeons, cardiologists, orthopaedists, pulmonologists, gastroenterologists, neurologists, medical geneticists, obstetricians, endocrinologists, haematologists, clinical psychologists – all in one place. Together they determine the therapeutic strategy for each patient according to their individual characteristics, the biology (type) of the tumour, taking into account comorbidities, family history and other risk factors.

The country’s first cardio-oncology team works in the high-tech hospital complex. Thanks to it, a number of patients with cardiovascular diseases or cardiovascular toxicity from the conducted oncological or oncohematological therapy, who otherwise would not be able to start anti-tumor therapy, actually not only conduct such therapy, but also achieve outstanding results. Guaranteeing this success is the close collaboration between cardiologists and oncologists and clinical haematologists.

Individual approach

The patient is at the centre of modern oncological, or oncohaematological, treatment, so the type of therapy and the sequence of treatment methods are strictly individual.

Target therapy and immunotherapy mark an exceptional advance in the therapeutic algorithms applied at Heart and Brain. Our medical geneticists routinely test biomarkers for predictive, prognostic and diagnostic purposes and determine a patient’s mutational profile so that the optimal individually tailored (personalized) therapeutic approach can be selected. The testing of certain molecular genetic markers provides information on the effectiveness and possible benefit of immunotherapy and the administration of targeted drugs. Timely molecular genetic analysis is part of successful treatment in patients.

Experienced specialists and high technology

The work of the centre is further enhanced by a state-of-the-art radiotherapy complex, equipped with the most technologically advanced linear accelerator in the country, a 4D computed tomography simulator for radiotherapy and radiosurgery planning and the country’s only latest generation gamma knife.

Stereotactic radiosurgery (SRS) is used to treat benign and malignant brain tumors, vascular diseases in the brain (arteriovenous malformations and trigeminal neuralgia), and in recent years, increasingly, brain metastases that some patients develop despite initial cancer therapy. The accumulated experience with the device shows that acute side effects associated with radiotherapy, such as nausea, vomiting, headaches, are in practice extremely rare in patients treated with gamma knife.

Radiosurgery is usually performed as a one-time procedure during a one-day hospital stay. It is much safer and less toxic than both standard neurosurgery, which involves incisions in the scalp, skull, brain membranes and tissue, and other types of radiotherapy, which require multiple exposures. The treatment is paid for by the National Health Insurance Fund.

Robotic oncogynaecology is the trademark of the clinic for maternal and child health “Mom and Me” – part of “Heart and Brain” in Pleven. For a year and a half, the specially trained specialists have performed more than 1,500 surgical interventions, one third of them related to gynaecological oncological diseases.

In addition to standard open and classic laparoscopic surgery, the clinic routinely performs surgery with the da Vinci robotic system. For the robotic gynaecological surgery the hospital has a contract with the NHIF. It brings a number of advantages – minimally invasive, with the lowest levels of trauma and postoperative pain, recovery is fast and patients can return to their normal routine in the shortest possible time. The hospital has a contract with the NHIF for robotic gynaecological surgery.

Breast cancer accounts for a quarter of all cancers and is the most common malignancy in women. In Bulgaria, only Heart and Brain performs sentinel axillary lymph node biopsy – the absolute standard in the treatment of early breast cancer. The method allows during the surgery to detect the lymph nodes that are first in the path of lymphatic drainage and metastasis. If these nodes are metastasis-free, it is assumed that the remaining nodes are also metastasis-free, i.e. that the lymphatic status is negative. There is no need to remove them, which makes the operation much more sparing. The specialists have the most advanced equipment for oncoplastic surgery.

Last year, world-renowned thoracic surgeon Prof. Dr. Diego Rivas and the Heart and Brain teams performed the country’s first uniportal robot-assisted lung resection. This minimally invasive intervention is highly suitable for lung cancer patients, especially those with hard-to-reach lung tumours.

The Heart and Brain Comprehensive Cancer Center’ also treats and diagnoses prostate, kidney, bladder, testicular, penile and ureteral malignancies. Urologists apply conventional and laparoscopic surgery of prostate and kidney, high-tech robotic da Vinci surgery, minimally invasive laser and bipolar surgery for bladder tumors. The teams also use a highly sensitive method to detect areas affected by bladder cancer. This approach allows 24% more tumours to be diagnosed, which is key to a better prognosis.

Starting in 2024, the high-tech Heart and Brain will launch a program to treat primary and metastatic malignancies of the peritoneum (the lining of the abdominal cavity). The hospital now has state-of-the-art equipment for the treatment of this type of disease. The HIPEC (hyperthermic intraperitoneal chemotherapy) and PIPAC (pressurised intraperitoneal aerosol chemotherapy) methods enable the control and, in some cases, complete cure of previously considered incurable primary and metastatic malignancies of the peritoneum. Patient fulfilment of strict criteria is key to inclusion in the programme and obtaining good treatment outcomes.

The doctor-patient relationship

Modern medicine offers hope, but it also poses new challenges for oncologists and their patients. With advances in science, experience, and the application of innovation to daily practice at every stage from diagnosis to treatment, physicians can offer better care and support to those battling cancer. And oncology and cancer treatment is a long-term process – in this challenge, the patient and the doctor are together all the way. Building trust is key to a good prognosis, and often doctors become part of the family.

Why Heart and Brain?

A team of skilled and established specialists, for whom patient trust and appreciation are of the utmost importance, work together in a high-tech environment. It is no coincidence that the Heart and Brain Comprehensive Cancer Centre is the first centre in the country to be certified as a member of the Organisation of European Cancer Institutes (OECI). This enables it to work within the European Cancer Network, sharing valuable experience to offer patients access to advanced personalised treatment based on evidence-based medicine.

Scientific contribution

From 26 to 28 January this year, the second national oncology scientific conference with international participation “The era of innovation in oncology: Innovation is our DNA” was held, organised by the Society of Oncopharmacology and Oncology. Heart and Brain’ specialists presented a number of their own studies that reflect the successes of their real clinical practice in areas such as medical genetics, cardio-oncology, stereotactic radiosurgery, breast cancer, peritoneal cancer and others.

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