Interventional cancer treatment involves the detection, diagnosis, and therapy of cancer with minimally invasive image-guided technology. Interventional radiologists can now treat many tumors in the body without the risks of open surgery or the side effects of systemic chemotherapy and radiation. It is a subspecialty that has resulted from the many advances made in interventional radiology over the last 40 years. Many of these techniques are the standard of care in the United States and worldwide. Interventional cancer treatment is a pillar of modern cancer care.
For many years, surgery was the only treatment available for many conditions. Systemic medical therapies such as chemotherapy can have severe, body-wide side effects. Today, minimally-invasive interventional radiology treatments provide targeted, first-line care for a variety of conditions without those adverse systemic effects. It is important to get a second opinion and know all of your treatment options before consenting to any procedure or surgery.
At ARA Diagnostic Imaging, highly trained interventional radiologists perform procedures ranging from biopsy to vascular access for palliative care to leading-edge cancer treatment, in addition to providing the excellence in diagnostic imaging that ARA has offered to Central Texas for over 65 years.
Interventional Cancer Treatment for Liver Cancer
Liver cancer is increasing in prevalence worldwide, and its incidence is growing at an unprecedented rate in the US and western countries. Many patients with liver tumors are not candidates for surgical resection or liver transplantation but can benefit from interventional cancer therapy. Interventional radiologists provide several minimally invasive options for liver cancer treatment, most of which are performed on an outpatient basis. Your cancer type, location, and whether it has spread are considered before therapy. A multidisciplinary approach that includes surgical and medical oncology is vital in determining the appropriate treatment choice.
Common liver cancers include:
Primary liver cancer:
- Hepatocellular carcinoma (HCC)
- Cholangiocarcinoma (bile duct cancer)
Secondary liver cancer:
- Colorectal cancer
- Neuroendocrine (also known as carcinoid)
- Breast cancer
- Other liver dominant metastatic cancers including pancreas, thyroid, and melanoma
ARA interventional radiologists perform several image-guided techniques to treat people with liver tumors who are not candidates for curative surgery. These techniques aim to control tumor growth and even downstage them to allow for curative surgery or transplant.
LIVER RADIOEMBOLIZATION WITH YTTRIUM 90 (Y90)
Y90 radioembolization resembles chemoembolization in that tiny particles are delivered to the tumor(s) through a catheter in the artery. Instead of a chemotherapeutic drug, the tiny particles are attached to a radioactive isotope called yttrium 90, which emits a highly-focused radiation into the tumor. The particles become lodged deep within the tumor and emit high-dose radiation in a very localized manner. The treatment can be repeated as needed.
Y90 radioembolization allows for the delivery of much higher, concentrated dose of radiation to the tumors than is achievable by external radiation therapy. This procedure is particularly useful in those patients with larger tumors and tumors with involvement of the portal vein in the liver. Newer studies are showing promise in smaller tumors, producing similar results to ablation, in a procedure called radiation segmentectomy. Treatment with Y90 has the added benefit of causing very few and usually mild side effects. Additionally, this procedure can be performed on an outpatient basis, which is convenient for the patient.
The latest research is now suggesting that Y90 radioembolization in combination with certain systemic chemotherapies can achieve improved outcomes for both primary and secondary liver cancer. ARA’s interventional radiologists will work closely with your medical oncologist to formulate a customized treatment plan.
Y90 radioembolization, also known as selective internal radiation therapy (SIRT), represents the state of the art in treatment of inoperable liver tumors. ARA Diagnostic Imaging has developed the first and only Y90 radioembolization program in central Texas and it is now offered at north, south, and central Austin locations.
LIVER ABLATION
Ablation is a technique that can reduce or destroy liver tumors by placing needle probes into tumors and applying heat, cold, or electrical current. These techniques are typically reserved for one or a few smaller tumors. The procedure is usually performed on an outpatient basis but sometimes requires an overnight hospital stay for observation and pain control.
Radiofrequency ablation This treatment device treats tumors by advancing a needle probe inserted through the skin into the tumor and applying precise, high energy radio waves that heat and kill tumor cells while sparing normal liver tissue surrounding the cancer.
Microwave ablation This treatment device treats tumors by advancing a needle probe inserted through the skin and applying highly-focused microwave energy to kill tumor cells while also sparing normal surrounding liver tissue.
Cryoablation This treatment device treats tumors by advancing a needle probe inserted through the skin and applying extreme cold temperature creating an ice ball to kill tumor cells while sparing normal surrounding liver tissue.
Irreversible electroporation Smaller liver tumors can be treated by advancing several needle probes through the skin into the tumor and applying electrical current to kill tumor cells. This technique is particularly useful when tumors are in close proximity to other vital structures that may be damaged with the extreme heat or cold of other techniques.
LIVER CHEMOEMBOLIZATION
In liver tumors that cannot be treated with surgery or ablation, chemoembolization is another minimally invasive option that is based on international guidelines for liver tumor treatment and is a standard of care worldwide.
A tiny catheter is guided through a needle puncture in the groin and into the arteries feeding the tumor(s). Highly concentrated chemotherapeutic agents and tiny particles are directly and precisely delivered to the tumors, sparing the normal liver tissue. In this way, the tumor cells are exposed to the anti-tumor drug while the arteries feeding the tumor are closed off by the particles, resulting in a dual treatment effect.
The procedure can be repeated multiple times approximately 4 to 6 weeks apart. It is usually outpatient based and patients are discharged the same day.
To schedule a consultation for interventional treatment for liver cancer, please call 512-467-XRAY (9729).
INTERVENTIONAL CANCER TREATMENT FOR KIDNEY TUMOR
Both malignant and benign tumors can affect the kidney. Renal cell carcinoma is the most common malignant kidney cancer. Minimally invasive techniques involving placing needle probes through the skin into tumors and applying heat or cold to destroy tumor tissue while sparing nearby normal tissue. These techniques are particularly appropriate for patients with one kidney, a genetic predisposition for multiple kidney tumors, and those patients who are not good surgical candidates. These treatments are typically reserved for small kidney tumors though some larger tumors may respond to treatment.
Cryoablation
This procedure treats tumors by advancing a needle probe inserted through the skin and applying extreme cold temperature, creating an ice ball that kills tumor cells while sparing normal surrounding kidney tissue.
Radiofrequency ablation
This procedure treats tumors by advancing a needle probe inserted through the skin and applying precise, high-energy radio waves that heat and kill tumor cells while sparing normal kidney tissue surrounding the cancer.
To schedule a consultation for interventional treatment of kidney cancer, please call 512-467-XRAY (9729).
The lung is the most common site for primary cancer worldwide. Smoking tobacco is the leading risk factor. The lung is also a common site of metastases from various other cancers. Metastases occur when a single tumor cell or clump of cells gain access to the blood stream or lymphatic system, travel to a new organ such as the lung, begin to multiply, and then regrow.
Interventional radiologists can deliver treatments for lung cancer directly to the cancer by “heating” the cancer (radiofrequency ablation), or “freezing” it (cryoablation). Since these techniques are delivered to the cancer in a very focused way, patients have fewer overall side effects making this especially useful in patients with other significant medical problems who are not candidates for surgery.
Bones are the third most common location where cancer cells spread and metastasize. Some bone metastases become painful as the tumor destroys the bone, creating holes that make the bone thin and weak. If left untreated, bone metastases can eventually cause the bone to fracture, seriously affecting a patient’s quality of life.
The primary goal of treating bone tumors is not curative, but rather palliative to reduce pain, prevent additional bone destruction, and improve function. In treating cancer patients with painful bone metastases, interventional radiologists use radiofrequency ablation (RFA) and cryoablation. Studies have demonstrated that RFA significantly reduced bone pain from metastatic disease in over 90 percent of patients who had failed or were not suitable candidates for conventional therapy. In these studies, only a few patients showed any side effects or complications. Therefore, RFA was demonstrated to be safe and effective in selected patients. Alternatively, in a technique called transcatheter embolization, ARA interventional radiologists can inject tiny particles through a catheter and into the artery that supplies blood to the tumor. The particles reduce the tumor’s blood supply, thereby reducing pain and decreasing the likelihood of bone fracture.
Benefits
- Interventional cancer treatment techniques can be performed under conscious sedation or general anesthesia.
- Procedures can often avoid the need for more invasive open surgery.
- Procedures are generally well tolerated. Most patients can resume their normal routines the next day.
- Most procedures can be repeated if necessary.
- Interventional cancer treatments can be combined with other treatment options and regimens.
- Procedures can relieve pain and suffering for cancer patients, improving quality of life.
- In liver cancer patients, interventional techniques can reduce tumors enough to allow for curative surgery.
Risks
- While extremely rare, there is a risk of allergic reaction to contrast material containing iodine. ARA radiologists are well prepared in the event of such a reaction. If you have had an allergic reaction to contrast material in the past, your radiologist may recommend that you take medication for 24 hours before the procedure to reduce risk.
- During many interventional procedures, a small incision is made in your skin to access a vein through which your radiologist will guide a catheter or needle to the treatment site. Access typically is through an artery in the groin but can also be in other areas depending on the procedure. Complications may include bruising, bleeding, hematoma, blood vessel damage and infection. Your radiologists and technologists are trained to minimize the risk of complication.
- Pregnant women should avoid radiation exposure if possible. Talk to your doctor or technologist about the risks of radiation exposure if you are or might be pregnant.
- The American College of Radiology (ACR) says that current information suggests that breastfeeding is safe after the use of intravenous contrast. Please discuss your breastfeeding options with your physician.
- Interventional procedures are either done at an ARA imaging center or a hospital and usually take 30 minutes to several hours, depending on the complexity of the procedure. Rarely some complex procedures take longer. Our highly trained interventional radiologists will counsel you on what to expect.
- You will be asked to remove all metal and jewelry and to change into a gown.
- You will lie on an exam table, and you will be connected to devices that monitor your blood pressure, heart rate, and blood oxygen level.
- An intravenous (IV) line will be placed in a small vein of your hand or arm. You may be given a mild sedative. In some cases, general anesthesia is used.
- During most interventional procedures, a small incision is made in your skin to directly access the treatment site or to access an artery through which your radiologist will guide a catheter to the treatment site. Many interventional cancer treatments are delivered directly to the tumor using a needle inserted through the skin. Before making the incision or performing any intervention, maximum sterile technique is used, and the area is covered with a sterile drape. An injection of local anesthetic is typically given at the site of insertion.
- A catheter or needle will be inserted through the skin or into the vein and guided to the treatment site using imaging such as CT, MRI, or fluoroscopy.
- Once the needle or catheter has been guided to the area to be treated, the interventional radiologist will use it to deliver the treatment.
- More images may be taken to make sure the treatment was completed effectively.
- When the procedure is finished, the needle or catheter is removed, and pressure applied to the incision site. A small bandage is placed over the incision site – stitches are not needed.
- You may be asked to rest in bed after the procedure, usually for about to 2 to 3 hours.
- You should be able to resume most of your normal activities within a day and feel recovered from the procedure within a few days.
- Wear comfortable, loose-fitting clothing. You may want to leave all jewelry, piercings and any other metal objects at home.
- You will be asked not to eat or drink anything after midnight before the procedure. You should stop taking aspirin and vitamin E for at least 5 days prior to the procedure. Ask your doctor for specific directions about your daily medications especially if you take any diabetes medication (insulin, etc.), blood thinners (coumadin, warfarin, etc.) or NSAIDs (ibuprofen, naproxen, etc.).
- Be sure to tell your radiologist about any illness or allergies you may have. Also, provide a list of your current medications.
- Inform your radiologist if you are or might be pregnant. You doctor may recommend an alternate treatment if you are pregnant.
- Since you will be sedated, please plan to bring a friend or relative to drive you home. You will be kept for observation at the facility until you are cleared to leave and should not plan to drive for 24 hours following the exam.
To schedule an interventional cancer treatment procedure, please call our interventional team at (512) 467-XRAY or (512) 467-9729. A provider referral is required to make an appointment.
Our specialized interventional radiologists and your referring health care provider typically provide follow-up care after your tumor treatment with imaging, clinical visits, and procedural results.
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