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Interventional oncology jan 2013

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Interventional oncology jan 2013

  1. 1. Michigan Society of Interventional Radiology - RFS Imaging, Technology, Innovation, Patient-Care
  2. 2. MSIR Annual Meeting • Feb 7th 2013! – www.mi-sir.org more info TBA • At the Detroit Institute of Art (DIA) – Enter the Research and Art competition! • $500 First place medical student research prize • Show off your art in medicine at the DIA – Speaker: • Filip Banovac MD – VIR Chief and Fellowship Director @ Georgetown University Medical Center • Med Student tickets are limited
  3. 3. New! - MSIR Student Ambassador Program • Open to new 2nd year students - ANNUALLY • Extend our educational efforts to medical schools across the state • Unify the schools and students • Provide students with leadership, mentorship and networking opportunities • Improve awareness of IR and MSIR
  4. 4. Applications are online: www.mi-sir.org
  5. 5. Intro to Interventional Oncology (IO)
  6. 6. What is an Interventional Radiologist? • “Interventional radiologists are board-certified physicians who specialize in minimally invasive, targeted treatments. They offer the most in-depth knowledge of the least invasive treatments available coupled with diagnostic and clinical experience across all specialties. They use X-rays, MRI and other imaging to advance a catheter in the body, usually in an artery, to treat at the source of the disease internally. As the inventors of angioplasty and the catheter-delivered stent, which were first used in the legs to treat peripheral arterial disease, interventional radiologists pioneered minimally invasive modern medicine.” • “Today many conditions that once required surgery can be treated less invasively by interventional radiologists. Interventional radiology treatments offer less risk, less pain and less recovery time compared to open surgery.” Source: www.sirweb.org
  7. 7. IO - Categories • Ablation – Cryoablation – Radiofrequency ablation – Microwave ablation – [EtOH injection] • Embolization – Bland Embolization – Chemoembolization – Radioembolization
  8. 8. Ablation – General Concept • Percutaneous (in IR) using image-guidance – Minimally invasive through skin (no incisions) • Probes deliver energy to the target zone – Energy denatures tissues and tumors causing cell death Probe =>
  9. 9. Cold – Cryoablation • Uses extreme cold – FDA approved 1999 – Joule-Thomson Principle and utilize inert Argon and Helium gases – Tissues can be frozen to below -100℃ within 30 seconds • Mechanism: 1. Rapid formation (and thawing) of ICE crystals within cells thereby disrupting membranes, and interrupting cellular metabolism among other processes; 2. Coagulation of blood thereby interrupting blood flow to the tissue in turn causing ischemia and cell death; and 3. Induction of apoptosis, programmed cell death cascade. • Treat solid tumors of kidney, prostate, lung, liver, breast, skin, and soft tissue. Image adopted from: www.cancertherapychina.com Article: “Tumor Targeted Cryoablation”
  10. 10. Cryoprobes Schematic of isotherms for Endocare cryoablation probes; data obtained after freezing for 10 minutes in gelatin. −40° isotherm gives reliable necrosis.1 1. Ullrick et al. Cryoablation in the Musculoskeletal System. CurrProbl Diagn Radiol 2008; 37: 39-48. 2. Williams et al. Cryoablation of Small Renal Tumors. EAU-EBU Update Series 5 (2007): 206-218. (1) (1) (1) (2)
  11. 11. Cryoablation Cases Renal Atwell et al. Percutaneous Cryoablation of 40 Solid Renal Tumors with US Guidance and CT Monitoring: Initial Experience. Radiology 2007; 243: 276-283.
  12. 12. Heat – RF vs Microwave • Radiofrequency: heat energy produced by alternating current – Lung, kidney, breast, bone and liver tumors – Cardiac; Varicose veins; pain management • Microwave – faster heating, larger heating zone per probe http://www.hopkinsmedicine.org/liver_tumor _center/treatments/ablative_techniques/radio _frequency_ablation.html
  13. 13. RF case 1 Choi et al. Radiofrequency ablation of liver tumors: Assessment of Therapeutic Response and complications. Radiographics 2001; 21: S41-S54.
  14. 14. RF Case 2 PRE POST Rhim et al. Essential techniques for successful radiofrequency thermal ablation of malignant hepatic tumors. Radiographics 2001; 21: S17-S35.
  15. 15. Embolization • A nonsurgical, minimally invasive procedure performed by an interventional radiologist involving selective occlusion of blood vessels by purposely introducing emboli – Bland embo: Inactive particles cause vaso-occlusion -> Ischemia – Chemoembo: Vaso-occlusive + targeted HIGH dose chemo – Radioembo: Liver-directed; HIGH dose radiation primarily to tumor Example: Uterine Artery Embolization Source: www.sirweb.org
  16. 16. Gain femoral access
  17. 17. Bland – UFE/UAE
  18. 18. Chemoembolization • Administration of anticancer Rx directly to the tumor through selected source blood vessels • Allows for much higher chemo concentrations while decreasing systemic complications • Treats: hepatocellular ca, liver metastasis, colon cancer, carcinoid, ocular melanoma, sarcomas, other primary tumors • Can be used in combo with other treatments Lewandowski et al. Transcatherter Intraarterial therapies. Radiology 2011; 259: 641-657.
  19. 19. TACE Trans-arterial chemoembolization is currently defined as the infusion of a mixture of chemotherapeutic agents with or without iodized oil, followed by embolization with particles Lewandowski et al. Transcatherter Intraarterial therapies. Radiology 2011; 259: 641-657.
  20. 20. TACE http://www.hopkinsmedicine.org/liver_tumor _center/treatments/intraarterial_therapies/
  21. 21. TACE case Pre Post Lewandowski et al. Transcatheter Intra-arterial therapies. Radiology 2011; 259: 641-657.
  22. 22. Radioembolization • Selective internal radiation therapy (SIRT) • Similar endovascular embolization techniques but with a unique planning protocol – Visceral MAA then radioembolization • Beads (5-30 microns) emit beta radiation which is harmful. The beads are selectively embolized to areas of tumor. • Radiation travels millimeters or less and eventually decays
  23. 23. www.brighamandwomens.org Visceral Angiogram and MAA infusion
  24. 24. Hypervascular metastatic neuroendocrine tumor Atassi B et al. Radiographics 2008;28:81-99 Complete 100% Response
  25. 25. Atassi B et al. Radiographics 2008;28:81-99
  26. 26. mCRC Pre-SIRT Post-SIRT Atassi B et al. Radiographics 2008;28:81-99
  27. 27. Conclusions • The various ablation and embolization options are essential tools in cancer care given the appropriate indications. • It is important to be aware of all the potential treatment options for your patients and this is required when obtaining informed consent • If in doubt, consult Interventional Radiology for more information
  28. 28. Contact Info: www.mi-sir.org Dhruv Patel MD Dmitry Goldin MD Narendra Panipatiya MD Max Pyko DO Faculty Advisors: Dr.s Monte Harvill - DMC, Daniel Croteau - HF, Joseph Ciacci - Beaumont We look forward to working with the bright young minds across the state!

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