Interventional oncology

Abstract

Over the course of the last century, cancer treatment evolved to a complex multimodality care pathway delivered by a multidisciplinary team including radiology, surgical, medical oncology and radiation oncology specialists. There is a continuous drive towards cure or control of cancer via minimally invasive techniques, reducing patient morbidity and improving quality of life. Interventional Radiologists have developed endovascular and percutaneous techniques for locoregional cancer treatment. This has become known as the fourth pillar of cancer care. Interventional oncology (IO) is a rapidly evolving specialty with frequent development and innovation, both in terms of interventional techniques and in the scope of cancer treatment. Once thought limited to salvage therapy and palliation, ablative and embolisation therapy is approaching equivalence to standard first line surgical care for certain tumours. Given the significant difference in morbidity and hospital stay, it is expected that IO techniques may supersede surgery for appropriate tumours in time. Patient care encompasses pre-procedure consultation and decision-making, admission and treatment, and follow-up imaging and care. The interventional oncologist is a clinician familiar with the key facets of cancer care and is trained to diagnose and manage the side-effects and complications of their procedures. IO is broadly divided into endovascular therapy and percutaneous ablation. Endovascular therapies involve access via the arterial system into the arteries suppling the tumour and direct delivery of chemotherapy and/or embolic material. Ablative techniques involve direct thermal or chemical destruction of the tumour via percutaneous delivery of an ablative device under image guidance. The principles of these techniques will be discussed, followed by examples of current clinical practice.