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April 29, 2002
By Katka Krosnar, Prague
A row has broken out over a controversial new cancer treatment in the Czech Republic.
Bowing to pressure from patients, Horska Hospital in Vrchlabi, east Bohemia, has agreed to perform, from next month, the "devitalisation" treatment, which "suffocates" tumours by tying them up and cutting off the blood supply but leaves them in the body.
The hospital’s unprecedented move comes despite a lack of official approval. The health ministry suspended trials of the treatment at four hospitals, including Horska, late last year, six months after launching them.
Health ministry spokesman Otakar Cerny told the BMJ that the trials had shown "no significant benefit to human health" but that the results were still being evaluated. Of the 200 patients in the final stages of cancer on whom the treatment was tested, 80% died, although Cerny conceded that they had been seriously ill and might have died anyway.
But the ministry says it is powerless to stop any hospital offering a treatment if it wants to.
"I am surprised that the hospital is offering this operation," Cerny said. "It is a very risky move. If a patient dies after undergoing devitalisation the hospital faces the risk of being sued by their family."
The Czech Doctors’ Association opposes the method and has vowed to report any cases of Horska using the treatment to the police.
"The vast majority of doctors do not believe devitalisation can play a significant role in treating cancer," David Rath, head of the association, said. "If the police discover that a patient’s health suffered after having this operation the doctor responsible would risk punishment."
Dr Vladimir Dryml, director of Horska Hospital, told the BMJ that he did not fear legal action. "No doctor who performed an operation in trying to help a patient could be found guilty by a court," he said.
On the basis of interest expressed by dozens of patients with cancer, Dr Dryml expects his hospital to carry out up to 10 devitalisation operations a month. "In our trials the operation prolonged life in 10-15% of patients," Dryml said.
The method was discovered by Czech surgeon Karel Fortyn, who died last year, but who dedicated his working life to developing and testing the procedure on animals. "Strangling" the tumour, Dr Fortyn said, caused it to die and decompose, without the need for chemotherapy or radiotherapy.
Although most of his tests were on melanomas, he said the treatment could be effective in most cancers. But his method is controversial because it involves leaving dead tissue inside the body and so risking infection—a risk Dr Fortyn denied.
The Czech Association of Patients is campaigning for the method to be tested more widely, complaining that trials were limited to seriously ill patients who had already undergone chemotherapy or radiotherapy, against Dr Fortyn’s recommendations. The Czech Doctors’ Association agrees that the trials should have included patients in earlier stages of cancer and points out that the trials did not include a control group.
Dr Fortyn discovered the technique in 1957, shortly after he graduated from medical school. During a routine operation he found that a patient’s stomach was infested with tumours and, acting on impulse and assuming that the patient could not be saved, tied off half of it with surgical string. The patient lived for some time.
Source: BMJ 2002;324:996 ( 27 April 2002)
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