OMICS Journal of Radiology
Open Access

Cancer Treatment; Interventional Radiology; Medical imaging

Introduction

Cancer is a formidable adversary, affecting millions of lives worldwide. However, in the ever-evolving landscape of medical science, innovative techniques have emerged to augment traditional cancer treatment methods. Among these, interventional radiology (IR) has emerged as a powerful tool for enhancing cancer treatment outcomes. In this article, we will delve into the world of IR [1], exploring its remarkable capabilities and the ways in which it is transforming cancer care. IR techniques may be used to place central venous access devices with well-established safety and efficacy. Therapeutic applications of IR in the oncology patient include local tumor treatments such as trans arterial chemo-embolization and radiofrequency ablation, as well as management of complications of malignancy such as pain, organ obstruction, and venous thrombosis [2].

The direct visualization enabled by image guidance during biopsy permits safe passage of a needle into an organ or mass, improving efficacy and minimizing trauma to surrounding structures. These minimally invasive techniques are applicable to a wide range of biopsy sites and, in most organ systems, have been demonstrated to be highly accurate with a low complication rate. In biopsy planning, modern cross-sectional imaging techniques help define lesion location, accessibility, and suitability for biopsy and aid in ensuring the correct lesion is sampled in the context of multiple lesions [3]. In selected cases where lesions are present in more than one organ, percutaneous biopsy may be used to concurrently confirm histological diagnosis and establish oncological staging by sampling the lesion suspicious for metastasis. With improving histological and cytological techniques, particularly in immune histochemical analysis, histological and possibly molecular examination may determine with more certainty the probable underlying primary tumour site and can predict sensitivity to chemotherapeutic drugs in some cases. In cases where surgical biopsy remains the preferred diagnostic approach, pre-operative tumour localization can be performed with image guidance in many situations; an example of this is wire-localization prior to excisional breast biopsy and in the chest to guide video-assisted thorascopic surgery (VATS) for removal of lung nodules that would otherwise require open thoracotomy [4]. Increasingly, percutaneous biopsy is utilized for microbiological diagnosis of lesions suspicious for opportunistic infections (particularly fungal) in oncology patients with febrile neutropenia.

The basics of interventional radiology

Interventional radiology is a subspecialty of radiology that employs minimally invasive procedures guided by medical imaging to diagnose and treat diseases. What sets IR apart is its ability to combine the precision of medical imaging with the therapeutic aspects of medical procedures. This fusion allows interventional radiologists to target tumors and other abnormalities with unparalleled accuracy [5].

Strategies employed include stimulation of the immune response to the tumour, reduction of oncogenic expression, restoration of tumour suppressor gene function, alteration of susceptibility of proliferating tumour cells to chemotherapeutics, and modulation of angiogenesis. In an IR technique similar to that used in chemoembolization, genetic agents may be administered directly into the tumour mass by selective arterial injection, after which the vessel is embolised thus limiting adverse effects and prolonging agent dwell time which is believed to improve genetic transfer rate. As DNA has a limited ability to cross cell membranes [6], vector agents are used to optimize transfection rates and achieve adequate expression of the therapeutic molecule within a cell.

The role of IR in cancer treatment

Tumor ablation: IR techniques like radiofrequency ablation (RFA) and microwave ablation (MWA) are used to destroy tumors without the need for open surgery. By inserting a probe directly into the tumor, interventional radiologists can heat or freeze cancerous tissues, effectively eliminating them.

Tumor embolization: In cases where surgery is not an option, embolization techniques can be employed. This involves blocking the blood vessels that supply the tumor, starving it of nutrients and causing it to shrink. This can be a crucial treatment strategy for liver or kidney cancers [7].

Percutaneous biopsies: IR allows for the precise sampling of suspicious tissues for diagnostic purposes. This helps oncologists determine the type and stage of cancer, enabling personalized treatment plans.

Drug delivery: With the advent of targeted therapies, interventional radiologists can deliver chemotherapy drugs directly to tumors. This minimizes systemic side effects and increases the concentration of the drug at the tumor site.

Venous access: For cancer patients requiring frequent chemotherapy or intravenous treatments, IR can create and maintain central venous access, reducing discomfort and complications associated with repeated peripheral venous access [8].

Advantages of IR in Cancer Care

Minimally invasive: IR procedures are typically performed through small incisions, reducing the physical trauma associated with open surgery. This leads to shorter recovery times and less postoperative pain.

Preservation of healthy tissues: IR’s precision ensures that healthy tissues surrounding the tumor are spared, minimizing collateral damage and preserving organ function [9].

Outpatient procedures: Many IR procedures can be performed on an outpatient basis, allowing patients to return home on the same day.

Suitable for high-risk patients: Patients who may not be candidates for traditional surgery due to age or other medical conditions often find IR to be a viable alternative.

Case studies in IR’s impact on cancer care

Let’s look at a few examples of how interventional radiology has made a significant difference in cancer treatment:

Lung cancer: IR-guided ablation techniques have revolutionized the treatment of inoperable lung tumors. Patients who were once considered untreatable can now benefit from these procedures.

Liver metastases: IR plays a critical role in managing liver metastases, a common occurrence in colorectal cancer. Tumor embolization and ablation have become standard treatment options in such cases [10].

Pancreatic cancer: Inoperable pancreatic tumors can be treated with IR-guided stent placement to alleviate symptoms such as jaundice and pain.

Conclusion

Interventional radiology has emerged as a powerful ally in the fight against cancer. Its minimally invasive nature, precision, and versatility have expanded treatment options and improved outcomes for cancer patients. As technology continues to advance, the role of interventional radiology in cancer care is likely to expand even further, offering hope to those battling this formidable disease. As we continue to unlock the power of IR, we move closer to a future where cancer can be not just treated, but effectively managed and, in some cases, cured.

1. Rogers L, Barani I, Chamberlain M, Kaley TJ, McDermott M, et al. (2015) Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review. J Neurosurg 122: 4-23.

Indexed at, Google Scholar, Crossref

2. Sahgal A, Weinberg V, Ma L, Chang E, Chao S, et al. (2013) Probabilities of radiation myelopathy specific to stereotactic body radiation therapy to guide safe practice. Int J Radiat Oncol Biol Phys 85: 341-347.

Indexed at, Google Scholar, Crossref

3. Goldsmith BJ, Wara WM, Wilson CB, Larson DA (1994) Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 80: 195-201.

Indexed at, Google Scholar, Crossref

4. Rogers L, Zhang P, Vogelbaum MA, Perry A, Ashbyet LS, et al. (2018) Intermediate-risk meningioma: initial outcomes from NRG Oncology RTOG 0539. J Neurosurg 129: 35-47.

Indexed at, Google Scholar, Crossref

5. Combs SE, Adeberg S, Dittmar JO, Welzel T, Rieken S, et al. (2017) Skull base meningiomas: long-term results and patient self-reported outcome in 507 patients treated with fractionated stereotactic radiotherapy (FSRT) or intensity modulated radiotherapy (IMRT). BMC Cancer 17: 254.

Indexed at, Google Scholar, Crossref

6. Buerki RA, Horbinski  CM, Kruser T, Horowitz PM, James CD, et al. (2018) An overview of meningiomas. Future Oncol 14: 2161-2177.

Indexed at, Google Scholar, Crossref

7. Walcott BP, Nahed BV, Brastianos PK, Loeffler JS (2013) Radiation Treatment for WHO Grade II and III Meningiomas. Front Oncol 3: 227.

Indexed at, Google Scholar, Crossref

8. Anvari K, Hosseini S, Rahighi S, Toussi MS, Roshani N, et al. (2016) Intracranial meningiomas: Prognostic factors and treatment outcome in patients undergoing postoperative radiation therapy. Adv Biomed Res 5: 83.

Indexed at, Google Scholar, Crossref

9. Pollock BE, Stafford SL, Utter A, Giannini C, Schreiner SA, et al. (2003) Stereotactic radiosurgery provides equivalent tumor control to Simpson Grade 1 resection for patients with small- to medium-size meningiomas. Int J Radiat Oncol Biol Phys 55: 1000-1005.

Indexed at, Google Scholar, Crossref

10. Combs SE, Schulz-Ertner D, Moschos D, Welzel T, Rieken S, et al. (2013) Skull base meningiomas: Long-term results and patient self-reported outcome in 507 patients treated with fractionated stereotactic radiotherapy (FSRT) or intensity modulated radiotherapy (IMRT). Radiother Oncol 106: 186-191.

Indexed at, Google Scholar, Crossref