Interventional Oncology Treatment Techniques
At the Lifespan Cancer Institute, we use several interventional oncology (IO) approaches, aided by state-of-the-art imaging technology, to treat patients who have cancer.
Image-Guided Tumor Ablation (IGTA)
Microwave ablation and radiofrequency ablation (RFA) shrink or eliminate ("ablate") tumors by destroying them with heat. Cryoablation eradicates tumors by freezing them. Together, these treatments are known as image-guided tumor ablation (IGTA). They also are collectively called “thermal” ablation.
During these procedures, the doctor inserts a thin needle electrode through a tiny puncture in the skin using CT scan or ultrasound guidance. Energy is then delivered to the tumor to kill the cancer. In the months following ablation, the dead tumor cells are eliminated from the body through the natural healing process.
IGTA may be used alone or in combination with more conventional cancer therapies such as surgery, chemotherapy, and/or radiation treatment. Because of its safe, minimally invasive technique, IGTA can be an excellent option for those patients who are unable to tolerate surgery or the side effects of chemotherapy.
IGTA also is useful for shrinking tumors as a palliative measure to alleviate pain and improve quality of life.
The physician schedules follow-up imaging at regular intervals to monitor the treated site for any recurrence of disease. If tumor growth is found, thermal ablation treatments can usually be performed again to eliminate the cancer.
IGTA procedures can be performed with intravenous sedation on an outpatient basis, and usually take less than an hour of operating time. No stitches are needed; a small bandage is placed over the skin incision(s) when the treatment is complete.
With image-guided tumor ablation, there is less damage to adjacent tissues, and the risks of infection or blood loss are much lower than with conventional surgery.
Research has demonstrated that these procedures are just as effective as surgery for small tumors in some vital organs.
Tumor ablation is approved by the US Food and Drug Administration (FDA) and is considered very safe.
Advantages of Image-Guided Tumor Ablation
The advantages of IGTA include:
- It can be repeated if necessary.
- It is usually performed on an outpatient basis.
- The complication rate is low.
- There is minimal risk of infection or blood loss.
Peptide Receptor Radionuclide Therapy (PRRT)
PRRT is a treatment for tumors that arise from the neuroendocrine cells in the stomach, bowels, or pancreas. These cells make hormones that are released into the bloodstream and may cause symptoms such as flushing, light-headedness, and diarrhea.
The treatment medication is given in pill form, and is designed to seek and kill the tumor cells wherever they are in the body. PRRT medications are radioactive. Once absorbed by the tumor cells, the radioactivity kills them from the inside.
Transarterial Chemoembolization (TACE)
Like transarterial embolization, TACE uses a catheter and real-time X-rays (fluoroscopy) to pinpoint the tumor(s) in the liver and block the blood supply. However, in addition to injecting gelatin sponge particles into the blood vessels that feed the tumor(s), the interventional oncologist administers anti-cancer drugs (chemotherapy) directly to the tumor(s).
TACE treatments are performed for a variety of tumors in the liver. They are very effective treatments for very vascular (significant blood supply) tumors such as hepatocellular carcinoma (HCC) and metastatic neuroendocrine tumors. TACE also is effective for other metastatic cancers in the liver that have not responded well to IV chemotherapy, or for patients who cannot tolerate the side effects, such as nausea, vomiting, diarrhea, and hair loss.
Targeted TACE treatments allow a much higher concentration of cancer-killing drug to reach the tumor, and keep it in contact with the tumor for a longer time, compared to chemotherapy that is given through an IV and circulated throughout the body. These very strong, targeted treatments often kill more cancer cells than IV chemotherapy, with fewer side effects, because very little of the drug reaches other parts of the body.
Transarterial Embolization (TAE)
Transarterial embolization is a targeted procedure performed within the blood vessels. TAE blocks the arteries supplying the blood that nourishes a tumor. Deprived of blood, the tumor dies.
During TAE, a small puncture is made with a needle in an artery in the wrist or groin, and thin, flexible tube called a catheter is inserted. The interventional oncologist uses real-time X-rays (fluoroscopy) and contrast dye to visualize the blood vessels supplying nutrients to the tumor(s). Using imaging guidance, the catheter is advanced into those arteries.
Once the catheter is in position, tiny pieces of gelatin sponges or beads are injected. Blood carries these downstream to the tumor, where they become wedged in its tiny vessels. As the particles pile up, the arteries become blocked and blood flow to the tumor is stopped. It takes three to four weeks for the starving tumor cells to die.
TAE is used to treat some types of tumors in the liver, kidneys, or adrenal glands. This treatment is most effective for tumors that have a significant blood supply. Treatment takes an average of one to two hours to complete.
TAE usually is performed as an outpatient procedure, with sedation medications given through an IV line for patient comfort and relaxation.
Patients who experience significant pain immediately after the treatment may require IV medications to relieve it. These patients may stay in the hospital overnight and be sent home the following day when symptoms and side effects are well controlled.
Transarterial Radioembolization (TARE)
Transarterial radioembolization (TARE) uses imaging guidance to inject tiny particles of gelatin sponge through a catheter that is placed into the arteries that supply blood to tumor(s) in the liver. The particles (called spheres) are loaded with potent radiation that travels a very short distance (5 millimeters). The blood flow carries the radiation spheres downstream to the tumor, where they get trapped, killing the cancer cells over the course of eight to 10 weeks. Unlike in TACE or TAE, the spheres used in radioembolization treatments are very tiny and do not block the blood supply to the tumor. This is important because radiation therapy damages cells through a process called “oxidation,” which requires that the blood flow to the tumor is preserved.
The exact strength and amount of radiation given during the treatment is carefully calculated based on the size of the treatment zone and the tumor(s) being treated. Because this very strong radiation can damage any tissue it comes into contact with, great care is taken to ensure that the spheres can be delivered safely without traveling through the blood vessels to other parts of the body such as the bowels or lungs. For this reason, the treatment usually occurs as two separate procedures: targeting and treatment delivery. Both are performed in an outpatient setting.
Radioembolization allows delivery of very strong radiation doses right to where it’s needed the most, the tumor itself. In conventional radiation treatments, beams are aimed at tumors from outside the body. These often cannot deliver as much radiation to the tumor as TARE, because the radiation beams intended to eliminate the cancer also affect the healthy tissues they pass through.
Radioembolization is considered a type of internal radiation therapy, and is also called intra-arterial brachytherapy.
Tumor Treating Fields (TTF)
Tumor-treating fields (TTF) is a non-invasive, alternating electric field therapy that was first approved in 2011 for adult patients with glioblastoma multiforme (GBM) that recurred or progressed after chemotherapy. In October 2015, the US FDA also approved TTF in combination with adjuvant temozolomide as a treatment for patients with newly diagnosed GBM following surgery, chemotherapy, and radiation therapy, based on an improvement in survival. TTF is now standard of care for patients with newly diagnosed and recurrent glioblastomas, and it is listed as in the treatment guidelines from the National Comprehensive Cancer Network (NCCN).
TTF uses a device that attaches directly to the patient’s head to deliver electromagnetic field therapy using low-intensity electrical fields to the brain. The device is portable and battery-operated. This treatment has a multitude anti-cancer effects. It is thought to slow or reverse tumor growth by inhibiting mitosis during metaphase, anaphase, and telophase. The alternating electric fields also disrupt the integrity of nuclear and cell membrane of tumor cells, sensitizing them to be removed by the host’s immune system,
TTF is also approved for the treatment of mesothelioma. A recently completed clinical trial showed that TTF also prolonged the survival of patients with advanced stage non-small cell lung cancer. Currently, there are additional clinical trials being conducted for brain metastases (lung and melanoma), pancreatic cancer, and ovarian cancer.
Vertebroplasty is a procedure to treat bone pain when cancer has spread to the spine or pelvis. It uses X-ray guidance to place needles into the bones where the tumor has spread and is causing severe pain. “Cement” is injected through the needles to strengthen the bone where the tumor has broken it down.
The “cement” hardens within minutes, and many patients experience rapid pain relief. The treatment is considered palliative—a comfort measure—and is very effective at providing relief for patients who are on high doses of pain medications, or those for whom pain pills aren’t sufficient. These treatments, like most interventional oncology therapies, are usually performed as an outpatient procedure under intravenous sedation.
Vertebroplasty can be performed alone or in combination with other treatments (such as radiation therapy or thermal ablation) to kill the tumor in addition to strengthening the bone that the tumor has eroded.
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