Journal of Radiology
Open Access

In the dynamic landscape of cancer care, Interventional Radiology has risen as a transformative force, navigating the intersection of radiological precision and holistic patient management. This article elucidates the expansive role of Interventional Radiology in oncology, encapsulating its evolution as a discipline that transcends traditional diagnostic boundaries. IR has also assumed an important place in the management of the complications of malignancy, which may result from malignancy itself or secondary to treatment. This paper provides an updated overview of the role of IR in the management of the oncology patient [1].

Appropriate treatment of malignancy is dependent on a timely definitive diagnosis and on accurate staging of disease. While noninvasive imaging techniques have improved assessment and staging for cancer, histologic confirmation remains the gold standard for definitive diagnosis of many tumours [2]. Biopsies to establish histological diagnosis are increasingly performed using minimally invasive techniques by interventional radiologists.

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 wirelocalization 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 [3]. Increasingly, percutaneous biopsy is utilized for microbiological diagnosis of lesions suspicious for opportunistic infections (particularly fungal) in oncology patients with febrile neutropenia. Choice of image guidance modality is multifactorial and there are many available options. Ultrasound offers the benefit of real-time imaging allowing accurate monitoring of the needle trajectory through tissues en route to the target lesion, with the dual advantage of avoiding patient and staff exposure to ionizing radiation during the biopsy. When lesions are visible by ultrasound, with suitable equipment and appropriate operator experience, this modality can provide equivalent or superior guidance to CT at time of biopsy. CT guidance offers enhanced anatomical detailing and delineation with more precise needle localization when compared to ultrasound [4].

Precision Diagnostics

At the forefront of Interventional Radiology’s contributions lies its prowess in precision diagnostics. Through refined procedures such as biopsies and fine-needle aspirations, IR illuminates the path to an accurate cancer diagnosis, laying the foundation for tailored therapeutic strategies [5]. The marriage of radiological insights and pathological

Minimally Invasive Therapies

The landscape of cancer treatment has been reshaped by the advent of minimally invasive therapies orchestrated by Interventional Radiology. Techniques like radiofrequency ablation and cryoablation orchestrate targeted assaults on tumors, sidestepping the need for invasive surgeries. This paradigm shift not only accelerates recovery but also mitigates the physiological toll on patients, ushering in a new era of patient-centric care [6].

Tumor Embolization

In the intricate choreography of cancer treatment, Interventional Radiology assumes a lead role through tumor embolization. By strategically obstructing blood vessels that sustain tumors, interventional radiologists curtail the nourishment of cancerous entities. This nuanced approach presents an alternative avenue for addressing tumors deemed surgically elusive, accentuating the diversity of therapeutic strategies at the oncologist’s disposal.

Pain Management and Palliative Care

The symphony of Interventional Radiology extends its resonance into the realm of pain management and palliative care. Nerve blocks, vertebroplasty, and kyphoplasty emerge as virtuoso interventions, orchestrating relief for cancer-induced pain [7]. Beyond targeting the physical aspect, these interventions harmonize with palliative care, enriching the quality of life for patients traversing the delicate corridors of advanced cancer.

Multidisciplinary Collaboration

The success of Interventional Radiology in the oncological landscape finds its zenith in a symphony of collaboration. Radiologists,oncologists, surgeons, and an array of healthcare protagonists unite in tumor board conferences, orchestrating a harmonized approach. This multidisciplinary amalgamation cultivates an ecosystem where each specialty’s nuances converge, yielding comprehensive treatment plans that transcend individual expertise [8].

Gene Therapy

Advances in molecular oncology and tumour immunology have facilitated the development of gene therapy in the treatment of malignancy. 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 chemoembolisation, 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 [9]. As DNA has a limited ability to cross cell membranes, vector agents are used to optimize transfection rates and achieve adequate expression of the therapeutic molecule within a cell. Common vectors include plasmids and phospholipid agents, which have short-lived effects, and viruses (retroviruses, adenoviruses, EBV), which have demonstrated more lasting genetic expression.

Image-Guided Therapies

The canvas of Interventional Radiology is painted with the hues of image-guided therapies, an avant-garde approach to cancer treatment. Leveraging cutting-edge imaging technologies such as fluoroscopy, ultrasound, and CT scans, IR engineers a symphony of precision. This not only facilitates the accurate targeting of tumors but also minimizes collateral damage, epitomizing a paradigm shift towards meticulous, image-guided therapeutic interventions.

Post-Treatment Surveillance

The narrative of Interventional Radiology extends beyond the crescendo of treatments into the epilogue of post-treatment surveillance [10]. Imaging modalities like PET and MRI, guided by the discerning eye of interventional radiologists, serve as sentinels, vigilantly monitoring treatment efficacy and detecting incipient signs of recurrence. This vigilance on the post-treatment frontier amplifies the prospects of timely intervention and augments the long-term trajectory of patient outcomes.

Conclusion

Interventional Radiology emerges not merely as a discipline but as a transformative force in the multidisciplinary orchestration of oncological care. Its evolution from diagnostic precision to therapeutic innovation embodies a paradigm shift in the landscape of cancer management. As the synergies between radiology and oncology deepen, the role of Interventional Radiology promises to be a dynamic force, shaping the contours of personalized, multidisciplinary patient care in the ongoing saga of the oncological journey.

1. Hanauer SB, Sandborn WJ (2019) Management of Crohn's disease in adults. Am J Gastroenterol 114: 529-554.

Indexed at, Google Scholar

2. Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, et al. (2018) ACG clinical guideline: management of Crohn's disease in adults. Am J Gastroenterol 113: 481-517.

Indexed at, Google Scholar, Crossref

3. Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, et al. (2018) Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 390: 2769-2778.

Indexed at, Google Scholar, Crossref

4. Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L (2017) Crohn's disease. Lancet 389: 1741-1755.

Indexed at, Google Scholar, Crossref

5. Baumgart DC, Sandborn WJ (2012) Crohn's disease. Lancet 380: 1590-1605.

Indexed at, Google Scholar, Crossref

6. Khor B, Gardet A, Xavier RJ (2011) Genetics and pathogenesis of inflammatory bowel disease. Nature 474: 307-317.

Indexed at, Google Scholar, Crossref

7. Danese S, Fiocchi C (2011) Ulcerative colitis. N Engl J Med 365: 1713-1725.

Indexed at, Crossref

8. Loftus EV Jr. (2004) Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 126: 1504-1517.

Indexed at, Google Scholar, Crossref

9. Kaplan GG, Ng SC (2017) Understanding and preventing the global increase of inflammatory bowel disease. Gastroenterology 152: 313-321.

Indexed at, Google Scholar, Crossref

10. Matsuoka K, Kanai T (2015) The gut microbiota and inflammatory bowel disease. Semin Immunopathol 37: 47-55.

Indexed at, Google Scholar, Crossref