Interventional Oncology has been a rapidly growing field over the last fifteen years. Diagnostic radiology has been integral to both diagnosis and surveillance of cancer and its treatments. Tissue biopsy is now used in the majority of tumour diagnosis, as confirmation of the type of tumour and increasingly to examine how receptive tumours will be to certain chemotherapy treatments.
Embolisation in Interventional Oncology
Embolisation has been used for a number of decades to treat liver tumours and metastases, as well as to deliver chemotherapy directly to the tumour. This has principally been used for cancer of the liver (Hepatocellular carcinoma (HCC) or Hepatoma), in which a number of well designed studies have demonstrated prolongation of life with this treatment. More recently treatments have expanded to other sites in the body as well as other tumours including metastases.
There are generally three different types of embolisation used in Interventional Oncology.
TACE – Transarterial chemoembolisation
This is the oldest and most studied therapy, whereby chemotherapy and particulate embolics (small particles that block blood flow) are injected into the arterial blood supply of the tumour.
DEB – Drug eluting beads
Chemotherapy here is loaded into the embolic beads (small beads that block the arterial blood supply to the tumour) so that it slowly infuses into the tumour.
SIRT – Selective internal radiation therapy
This therapy is a little different, in that the embolic agent or bead uses radiotherapy rather than chemotherapy to damage the tumour.
As to which of these therapies is better than the other is controversial and currently debated. It is likely that different therapies will suit different disease and goals.
Embolisation in interventional oncology is usually aimed to be life prolonging rather than curative.
Ablation therapies in interventional oncology are often aimed at being curative (but in some organ systems may be used more for control of disease and prolongation of life). The concept here is to place a needle (or number of needles) into the tumour and destroy that tissue either with chemical, temperature or electricity.
The advantages of ablative therapies are that they are usually minimally invasive (only require a very small cut, minimal injury to normal tissue, no surgeries, quick recovery times), and aims of therapy may be curative.
Types of Ablation Therapy
RFA – Radio frequency ablation
This is the most common type used in Australia and uses heating to irreversibly destroy the tumour cells.
This form of ablative therapy uses freezing to destroy the tumour cells.
Microwave Therapy is used to get greater heating to the tissues.
PEI – Percutaneous ethanol injection
Here dehydrated alcohol is injected into the tumour. This is usually reserved for small liver tumours.
IRE – Irreversible electroporation
A high voltage current is passed through the tumour to irreversibly destroy the cell wall.
Currently, ablative therapies are used widely for liver tumours and metastases to liver. It is also being increasingly used for some kidney tumours, lung tumours and bone tumours.
This is a complex field and if you would like to discuss any of these procedures further, please feel welcome to Contact Us.