• Interventional Radiology

    Interventional radiology offers a set of minimally invasive procedures to diagnose and treat conditions that, in the past, would require open biopsies and surgery. When used, these techniques result in shorter procedures with relatively lower risks and faster recoveries for patients.

    Our interventional radiologists are pioneering the adoption of interventional techniques for the diagnosis and treatment of pediatric cancer. Working alongside our surgical oncologists, are continuously expanding the role interventional radiology plays in our treatment plans, so children experience less risk, less pain, and a quicker recovery. 

    Interventional Radiology Overview

    Interventional radiology uses image-guided tools to deliver diagnostic and therapeutic procedures through catheters, needles, and tiny probes - tiny instruments inserted into small incisions or natural body openings - without leaving surgical scars or even sutures in most cases. When these techniques can be used in place of open surgery, the result is typically less invasive care with equal and sometimes improved effectiveness. While the use of interventional radiology for adults with cancer is much more developed than it is for children, many of the same techniques are used.

    Many diseases that were once diagnosed and treated surgically can now be treated non-surgically by interventional radiologists such as solid tumors in children and young adults. A number of factors go into deciding whether interventional radiology is appropriate for a patient’s condition, including the type and size of the tumor, the extent of the disease, and if it has spread elsewhere in the body. These techniques, which can be used for diagnosis or as primary treatments or palliative (comfort) care, include:

    Diagnosis

    We commonly perform core needle biopsies using image guidance, with patient selection based on a multidisciplinary oncology team discussion. CT, MRI, PET-CT, and PET MRI are used to help target the most active zone of abnormality. 

    Regional Therapy

    • Chemoembolization – the simultaneous delivery of anti-cancer medication directly to the tumor site and the deposition of particles designed to cut down the blood supply to the tumor. Chemoembolization is currently used to treat cancers of the endocrine system, liver cancer, and osteosarcoma, and is often referred to as TACE, or Trans Arterial Chemo Embolization.
    • Intra-arterial chemotherapy – the delivery of chemotherapy drugs to a tumor through a catheter placed directly into an artery. This achieves a very high local dose of drug to the tumor, increasing the efficacy of the treatment, while giving a low systemic dose, thus minimizing the systemic side effects. We currently offer an intra-arterial treatment pathway for retinoblastoma, as part of our multidisciplinary management of this condition.
    • Bland embolization – this technique closes the blood supply feeding the tumor or stops bleeding from blood vessels perforated by a spreading tumor, usually by injecting tiny particles via a catheter directly into the tumor blood supply. This is also useful as a pre-operative technique to prevent excessive blood loss during surgical removal of the tumor.

    Ablative Therapy

    • Radiofrequency ablation (RFA) – the placement of an electrode through a small needle to “burn” bone, liver, kidney or lung tumors and sometimes in soft tissue tumors. RFA has proven very effective in management of pain from bony metastases.
    • Cryoablation – the use of a hollow needle (cryoprobe) inserted through the skin, through which cooled fluids are circulated to destroy solid tumor tissue in the lung, liver, breast, kidney and prostate, as well as desmoid tumors, by freezing.
    • Percutaneous injection of cytotoxic agents like acetic acid and ethanol – these substances are instilled directly into tumors to kill the tumor cells and create necrosis. Hyper-functioning thyroid nodules in teenagers can be treated using this technique.
    • High-intensity focused ultrasound – the non-invasive application of high-intensity energy to locally heat and destroy diseased tissue, including prostate, liver, bladder and pancreatic tumors.

    Supportive Care

    • Central venous access – these central intravenous lines provide access for long term therapy and the medications needed for oncology patients. Temporary central lines, tunneled central lines and port-a-catheters can be placed by interventional radiologists, usually when done under the same anesthesia as the biopsy.
    • Gastrostomy – Feeding stomach or jejunal tubes can be placed to maintain nutritional status.

    Managing Complications

    • Thrombolysis – the injection of clot-busting drugs directly into the clotted blood vessels to re-establish patency.
    • Aspiration and drainage – removal of abnormal fluid accumulations, including ascites, pleural and pericardial effusions and abscesses. Percutaneous nephrostomy catheter placements for relieving obstructed kidney outflow.
    • Stenting – insertion of special tubes within the bile ducts or ureters to counter strictures and relieve obstructions. Blood vessels compressed externally by tumors can also be opened by stenting.
       

    Palliative Care

    • Pleurodesis – this technique is used to permanently close the pleural space in recurrent malignant pleural effusions.
    • Pain management – tumor related pain can be treated using various ablative techniques mentioned above, and act by destroying the pain nerves.
       
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  • Helping Cancer Survivors

    Lisa Diller, MD, shares some of the issues survivors of pediatric cancers face and why survivor programs are so important.