Less-Invasive, More Precise: How Interventional Radiology is Transforming Cancer Treatment
By Dr. Douglas Rivard, Medical Chairman, Radiology, Children’s Mercy
Over the past decade, Interventional Radiology (IR) has advanced thanks to technology and cutting-edge techniques. More recently, IR has played a vital role in the field of adult oncology, and these procedures have become a standard part of care. The fact is, if I get liver cancer, I’m not going to get a transplant as quickly as a child would get one, so other therapies have been developed in its place out of necessity.
There has unfortunately been some reluctance to adopt these new technology treatments in pediatrics, but we’re making headway, and therapy for image-guided ablation of pediatric tumors is emerging.
We have four pediatric Interventional Radiologists at Children’s Mercy, and collectively we perform more than 3,000 procedures a year. We have very comprehensive offerings, and in addition to more common procedures, each of us participate in innovative procedures, including tumor ablation, complex transplant interventions, and advanced image guided pain management, and embolizations.
One of the groundbreaking procedures we’ve performed is CT and ultrasound-guided cryoablation. We had a patient that had an aggressive tumor in their lower extremity that kept growing and was in constant pain. Another hospital had offered amputation as the only option, but our IR team was able to successfully perform a cryoablation where we froze the tumor with guidance of CT and ultrasound, precisely targeting the tumor while avoiding damage to adjacent tissues. While it was an extreme case, it’s an impactful example of what IR can achieve.
Another procedure we perform is chemoembolization with chemotherapy laded drug-eluting beads. Through a two-millimeter incision, we’re able to guide a catheter into the specific arteries to feed a tumor, which provides very focused and isolated delivery of chemotherapy right where it’s needed—at the tumor. This procedure ultimately eradicates the tumor by cutting off the blood supply and dosing with chemotherapy beads helps minimize the side effects associated with systemic chemotherapy regimens.
Portal vein embolization is another procedure where our team goes through the portal vein with a needle to block off the blood supply to the tumor and shrink it.
We’ve also performed image-guided microwave ablation where we use an ultrasound or CT to insert a needle directly in the tumor to either freeze it at low temperatures, or burn it with high temperatures.
Benefits of Interventional Radiology
There are many benefits to IR, and we’re at the forefront of using minimally-invasive image guided procedures in pediatric patients to achieve the most effective treatment. Conditions that once required surgery can now be treated non-surgically and performed as an outpatient procedure or during a short hospital stay.
Not only does IR allow us to be more precise in a patient’s treatment, it also reduces risk as well as pain and recovery time, which makes it less stressful and nerve-racking for both the patient and the family. Performing IR as an alternative to surgery also lowers overall costs, which is increasingly important as we move to a valued-based health care system.
Teamwork and Collaboration
To be successful, it’s important that the IR team collaborates with the surgery and oncology teams and vice versa. The reality is, transplants and chemo will never go away, and not every child will be a candidate for an IR driven minimally invasive image guided procedure. For example, if a child’s liver is completely diseased, then they’ll need a transplant. However, IR should be an option that can be used or combined with traditional treatment when appropriate.
That’s why teaming up with the pediatric oncologist and pediatric surgeon is so important. Together we review individual cases to recommend the best treatment plan - it just makes sense when you’re considering the best interest of the patient. If we can avoid giving a child a ton of chemo or make a major surgery easier for the surgeons, why wouldn’t we use this alternative treatment? Sometimes surgery may be the only way to go, but IR can be a good alternative for some kids. We enjoy a fantastic working relationship with our pediatric surgeons and pediatric oncologists that have fostered discussions to create new combinations of therapy, which has been critical to advancing pediatric oncology treatment.
The Future of Interventional Radiology
Emerging adult literature confirms what we already know that doing an image guided ablation of a single tumor instead of performing surgery is actually the better route to take. I believe that while we’re behind in the pediatric world, we’re making progress, and with more robust data and studies the field will continue to gain traction.
As an industry, we need to consider IR as an option for treating children, especially in the palliative situation or hospice care when all other traditional chemotherapy and other protocols have been exhausted. But more importantly, to incorporate IR proactively as a standard part of pediatric care early on in the clinical decision-making process. By working collaboratively and continuing to advance avenues of therapy, we’re poised to make a difference in childhood cancer treatment and pain management.
Dr. Rivard will present on emerging therapies at the 5th International Meeting of the Society for Pediatric Interventional Radiology 8 a.m. Saturday, Oct. 28, at the Art Hotel in Denver.
Learn more about medical imaging at Children's Mercy.