Interventional radiology offers a set of minimally invasive procedures for diagnosis, treatment, and palliative care for certain diseases, such as cancer. This subspecialty in interventional radiology is also known as interventional oncology. These procedures can be alternative options to open biopsies and surgeries, and are typically shorter, relatively less risky and associated with faster recovery.
Interventional oncology uses image-guided tools much like the GPS system to target the tumor area and perform diagnostic and therapeutic procedures in patients through the use of catheters, needles, and tiny probes (tiny instruments inserted into small incisions or natural body openings).
Procedures for diagnosis include image guided needle biopsy through the skin, angiography (study of blood vessels by injecting radiographic dye), and lymphangiography (study of lymph nodes by injecting radiographic dye). Treatments are targeted to tumors in the bone, eye, visceral organs (internal organs in the body that include the lungs, liver, kidneys, etc.) and soft tissues. In most cases, these procedures result in no trace of surgical scars or sutures (stitches).
Diseases such as solid tumors and bone tumors, which were once exclusively diagnosed and treated through surgery, chemotherapy, or radiotherapy, can now be treated through interventional oncology procedures. However, these procedures are not appropriate for all cancer patients but based on individual patient factors such as:
- The tumor’s type, size and location
- The extent of the disease
- Whether the disease has spread to other areas in the body
Interventional oncology can be used in adults and pediatric patients with cancer. Currently, there are established interventional oncology protocols to treat certain cancers in adults. This experience is being transferred to pediatric cancers where clinicians and researchers are expanding the ways it can be used to treat children. Some of the cancers that can be addressed with this modality ares:
- Soft tissue tumors such as Desmoid tumor
- Bone tumors such as osteoid osteoma, chondroblastoma, giant cell tumors, aneurysmal bone cysts tumors
- Liver tumors such hepatocellular carcinoma, hepatoblastoma, metastases
- Lung and kidney tumors
- Retinoblastoma
Pediatric cancer treatment and adult cancer treatment can be very different, and it is important to find an interventional radiologist who knows how to treat pediatric patients specifically.
Two types of interventional radiology techniques that are used to treat cancer include targeted regional and ablative therapy. Targeted regional therapy delivers a combination of anti-cancer medication and agents that block the tumor blood vessels to shrink and kill a tumor. Intra-arterial chemotherapy, for example, delivers chemotherapy drugs to a tumor through a catheter placed into an artery feeding the tumor. Similarly, small beads coated with radiation properties can be selectively delivered to the tumor to help shrink and kill tumors.
Ablative therapy uses either chemicals, heat energy, or cold energy applied locally to the tumor to destroy the tumor cells. In cryoablation, a hollow needle (cryoprobe) is inserted through the skin, through which cooled gases are circulated to destroy solid tumor tissue in the lung, liver, breast, kidney and soft tissues by freezing.
In addition to these procedures, interventional oncology also includes central venous access placement such as chemotherapy ports and PICC lines, especially in patients with difficult anatomy. Drainage tubes through small skin holes are placed to remove excess or infected fluid from body cavities. Palliative care procedures such as pleurodesis, nerve ablation, and tumor ablation help to reduce tumor-related pain and symptoms.
The interventional oncology team at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center is focused on advancing research in this area and further improving treatment options in pediatric cancers. This research includes making an archive of pediatric patients with solid tumors treated with interventional oncological procedures and developing a Biobank of samples and data in order to better evaluate the effectiveness of procedures and therapies.