INTERVENTIONAL ONCOLOGY: MOST EFFECTIVE WAY OF CANCER TREATMENT

Interventional Oncology:

Interventional oncology, practiced by interventional radiologists, is one of four parts of a multidisciplinary team approach in the treatment of cancer and cancer-related disorders. The others include medical oncology, surgical oncology, and radiation oncology.

Interventional oncology procedures provide minimally invasive, targeted treatment of cancer. Image guidance is used in combination with the most current innovations available to treat cancerous tumors while minimizing possible injury to other body organs.

Some of these therapies are regional, as when treating cancers involving several areas of the liver with chemoembolization or radioembolization.
Others are better classified as local, as when treating focal lesions in the kidney, liver, lung, and bone with cryoablation (freezing), or microwave or radiofrequency ablation (heating).
In general, these techniques are reserved for patients whose cancer cannot be surgically removed or effectively treated with systemic chemotherapy. These procedures are also frequently used in combination with other therapies provided by other members of the cancer team.

What types of cancer can benefit from IR?

For years, the mainstay of cancer treatment has involved chemotherapy, surgery, and/or radiation. With the advanced technology provided by IR, cancers that once required surgical removal or traditional chemotherapy can be treated percutaneously through a small puncture in the skin the size of an IV needle.

Almost all oncology patients will cross paths with an Interventional Radiologist at some point during their treatment regimen. Depending on the type of cancer, an Interventional Radiologist may become one of your primary physicians or serve as a consultant to your oncologist or surgeon.

Diagnosis of Cancer or Cancer-Related Diseases

IMAGING-GUIDED BIOPSY:

One of the most common interventional radiology procedures performed to diagnose or exclude cancer is an imaging-guided biopsy. Under fluoroscopic, CT or ultrasound guidance, small needles can be placed in areas of abnormality, and samples can be taken for cytologic or pathologic testing. With imaging guidance, biopsies of an abnormality can be obtained while important adjacent structures, such as blood vessels or bowel, may be avoided.

TRANSJUGULAR LIVER BIOPSY

The procedure consists of the insertion of a long, thin (19- to 20-gauge) biopsy device into the right internal jugular vein and moving it into the right or middle hepatic vein. Random biopsy samples can then be obtained from the liver. Because the samples are essentially taken from the “inside-out,” without traversing the liver capsule, the risk of extracapsular hemorrhage is decreased

IMAGING-GUIDED FLUID ASPIRATION

Imaging-guided aspiration of fluid collections is another diagnostic aid. Either CT or ultrasonography can be used to place a small (18- to 22-gauge) needle into a fluid collection to determine whether the collection is benign or malignant.

If indicated, a drainage catheter may be placed at the same time as the needle aspiration. Catheter drainage may be especially helpful in patients with the infected fluid collection or fluid collections that otherwise might require surgical drainage.

TREATMENT

 Interventional radiologists use a variety of techniques to treat cancer. These include ablation (burning or freezing a tumor), embolization (cutting off a tumor’s blood supply or targeting it with chemotherapy or radioactivity), and irreversible electroporation (punching holes in tumors with electric currents).

Other IR techniques can relieve pain. For example, vertebroplasty, kyphoplasty, and ablation are three methods we use to help patients with spine and other bony tumors.

ABLATION:

This method involves placing a needle into the tumor and delivering heat or cold to destroy the cancer cells. It requires no incisions and is effective for some patients who are not candidates for surgery and who have isolated tumors. Ablation is also used in bones either to relieve pain or sometimes to keep metastases (cancer cells that have spread) under control after resistance to targeted therapies. In addition to destroying tumors, we have been investigating ablation as a method to activate immune cells to attack any remaining cancer cells.

EMBOLIZATION:

In this technique, microscopic beads are injected into blood vessels that feed cancer. Sometimes these beads are used to cut off the blood supply to the tumor to suffocate and kill it; other times it is used prior to surgery so tumors can be removed more safely, without significant blood loss. The beads can also be filled with either radioactivity or chemotherapy, depending on the cancer type, and used to shrink or kill the tumor

IRREVERSIBLE ELECTROPORATION:

This is a new strategy we are currently studying that uses tiny needles to give cancer cells a jolt of electricity. The electricity produces holes in the cell membranes that destroy the cells, all without causing scarring or inflammation in nearby healthy tissues. IRE can be useful for treating tumors that are close to blood vessels and other sensitive structures — situations in which thermal ablation isn’t feasible

VERTEBROPLASTY AND KYPHOPLASTY:

Vertebral fractures are a common and painful side effect of spine tumors. During vertebroplasty, a special type of bone cement is injected directly into a collapsed vertebra to stabilize the spine before surgery or radiation therapy. The cement may also serve as a marker in patients who are treated with image-guided radiation therapy. Kyphoplasty provides spinal support and relieves pain, particularly in patients with spine tumors. A small balloon is inserted into the vertebra and inflated. This creates a space into which bone cement can be injected. Both of these procedures can also help improve patients’ mobility.