Interventional Radiology in Cancer Interventional Radiology in Cancer PatientsPatients

C. Douglas Edmondson, M.D., FACRC. Douglas Edmondson, M.D., FACR

Interventional and Diagnostic Interventional and Diagnostic RadiologistRadiologist

What does IR do?What does IR do?

DiagnosisDiagnosis Primary treatment of cancerPrimary treatment of cancer Treatment of cancer related Treatment of cancer related

complications or sequelaecomplications or sequelae

DiagnosisDiagnosis

Image guided biopsyImage guided biopsy Aspiration or Drainage of fluid Aspiration or Drainage of fluid

collectionscollections

Examples of Bx needleExamples of Bx needle

CT of needle in tumorCT of needle in tumor

Fluoroscopic image of needle in Fluoroscopic image of needle in lung tumorlung tumor

Ultrasound image of needle in Ultrasound image of needle in tumortumor

Malignant pleural fluid Malignant pleural fluid

Safe – T – Centesis CatheterSafe – T – Centesis Catheter

CXR before and after tapCXR before and after tap

Primary treatment of cancerPrimary treatment of cancer

Transcatheter chemoembolizationTranscatheter chemoembolization Transcatheter gene therapyTranscatheter gene therapy Central venous accessCentral venous access Tumor ablationTumor ablation

• SclerotherapySclerotherapy• Radiofrequency ablation (RFA)Radiofrequency ablation (RFA)• MicrowaveMicrowave• FreezeFreeze

ChemoEmboChemoEmbo

Typically in the hepatic artery for Typically in the hepatic artery for Hepatocellular Ca or susceptible Hepatocellular Ca or susceptible metastasis.metastasis.

Attacks the tumor with concentrated Attacks the tumor with concentrated dose of chemotherapy or radioactive dose of chemotherapy or radioactive beads and embolic materials to stop beads and embolic materials to stop blood flow to starve and poison the blood flow to starve and poison the tumor or fry it with Beta irradiation tumor or fry it with Beta irradiation OR all of these agents.OR all of these agents.

Before and after angiogramsBefore and after angiograms

CT scan of embolic material in liverCT scan of embolic material in liver

Radiofrequency AblationRadiofrequency Ablation

15 -18g needle or needles placed 15 -18g needle or needles placed into the tumor usually by CT into the tumor usually by CT guidance for best control.guidance for best control.

Radiofrequency applied across the Radiofrequency applied across the field and the tumor is coagulated and field and the tumor is coagulated and “cooked” at about 110 degrees.“cooked” at about 110 degrees.

Very promising results in many Very promising results in many applications. Ever expanding applications. Ever expanding indications.indications.

RFA needleRFA needle

CT of RFA in PlaceCT of RFA in Place

Before and After CT Scans of Before and After CT Scans of renal cell carcinomarenal cell carcinoma

Treatment of Cancer related Treatment of Cancer related complications or sequelaecomplications or sequelae

Pain ControlPain Control Vertebral interventionsVertebral interventions DrainageDrainage

Pain ControlPain Control

Pain usually arises from invasion Pain usually arises from invasion especially nerve involvement.especially nerve involvement.

Pancreatic cancer does not respond to any Pancreatic cancer does not respond to any conventional therapy when usually conventional therapy when usually discovered. Treat the terrible pain with discovered. Treat the terrible pain with celiac axis ablation.celiac axis ablation.

Other areas such as stelate ganglion in Other areas such as stelate ganglion in neck, spinal nerves as they leave the neck, spinal nerves as they leave the spinal foramina respond to image guided spinal foramina respond to image guided ablations.ablations.

Pancreatic Ca with Celiac axis Pancreatic Ca with Celiac axis ablationablation

Vertebroplasty/Vertebroplasty/KyphoplastyKyphoplasty

11 – 14 g needles placed into 11 – 14 g needles placed into vertebral body and PMMA cement vertebral body and PMMA cement injected.injected.

Eliminates pain in over 80% of Eliminates pain in over 80% of metastatic lesionsmetastatic lesions

Kills tumor with heat as cement Kills tumor with heat as cement hardenshardens

Stabilizes bone?Stabilizes bone?

Model of needle in vertebral bodyModel of needle in vertebral body

Needles and PMMA in the vertebra Needles and PMMA in the vertebra during Vertebroplastyduring Vertebroplasty

Needle and balloon in vertebra Needle and balloon in vertebra during Kyphoplastyduring Kyphoplasty

CT of PMMA in the boneCT of PMMA in the bone

Drainage and bypassDrainage and bypass

Biliary obstructionBiliary obstruction Ureteral obstructionUreteral obstruction Abcess and necrotic tumor mass Abcess and necrotic tumor mass

effecteffect Palliative thorocentesis or Palliative thorocentesis or

paracentesis (serial taps or paracentesis (serial taps or permanent catheter).permanent catheter).

Biliary Drain and StentBiliary Drain and Stent

Pleur-X drainPleur-X drain

SummarySummary

IR can aid with diagnosis, primary treatment, IR can aid with diagnosis, primary treatment, management of complications and palliation of management of complications and palliation of sequelaesequelae

IR can do many of these with equal or better IR can do many of these with equal or better success than conventional treatments success than conventional treatments

IR can do many procedures cheaper and with less IR can do many procedures cheaper and with less complications than more traditional approachescomplications than more traditional approaches

Nearly all procedures are OP and with local Nearly all procedures are OP and with local anesthetic and IVCS.anesthetic and IVCS.

Future procedures are on the bright horizon of IRFuture procedures are on the bright horizon of IR