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, they 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 - minute 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, such as solid tumors and bone tumors, can now be treated non-surgically by interventional radiologists. 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:
- 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. Typically, liver tumors are treated using this technique.
- 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. Retinoblastoma is commonly treated with this technique.
- Bland embolization – this technique closes the blood supply feeding the tumor, resulting in tumor shrinkage. It is also used to stop 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.
Yttrium-90 radioembolization – this is another minimally invasive targeted procedure which combines radiation treatment and embolization to treat hepatic tumors. Radioactive isotopes are directly delivered to the tumor bed which allows for effective tumor kill with reduced systemic toxicity from radiation. Liver tumors can be treated with this technique.
- 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. Bone and visceral tumors can be treated with RFA.
- Cryoablation – the use of a hollow needle (cryoprobe) inserted through the skin, through which cooled gases are circulated to destroy solid tumor tissue in the lung, liver, breast, kidney, and soft tissues by freezing.
- Microwave ablation (MWA) – this is another form of thermal ablation wherein needles are guided into the tumor and the tumor cells are killed by applying thermal energy. Liver, lung, and other visceral tumors can be treated using MWA.
- Laser ablation – laser fibers are guided into the tumor and heat energy is delivered to destroy the tumor cells. Bone tumors like osteoid osteomas can be treated with laser ablation.
- Chemical ablation (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; commonly used in tumors situated in challenging anatomical locations of the body.
- Percutaneous image guided needle biopsy – we commonly perform core needle biopsies using image guidance, with patient selection based on a multidisciplinary oncology team discussion. Contrast enhanced ultrasound, CT, MRI, PET-CT, and PET MRI are used to help target the most active and viable zone of abnormality.
- Angiography (arterial and venous) – this is a procedure to study blood vessels by injecting a radiographic dye via catheters placed in the groin blood vessels. This helps to delineate the blood vessels supplying the tumor or study the involvement of blood vessels within the tumor. This may be performed for treatment planning.
- Lymphangiography – in this procedure, lymph nodes in the groin are accessed and injection with dye to study the lymphatic drainage. This is helpful when there is excess or abnormal fluid accumulation in the abdomen or chest or lymphedema. This can be performed using fluoroscopy and magnetic resonance imaging.
- 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 primarily placed and also maintained periodically to allow for nutritional support.
- Thrombolysis – the injection of clot-busting drugs directly into the clotted blood vessels to re-establish patency of the blood vessels.
- 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.
- Lymphatic interventions – used to study any lymphatic leaks resulting from tumor invasion or post treatment. In cases where leaks are identified, these are closed with embolization.
- 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.
Dana-Farber/Boston Children’s patients have access to a Pediatric Interventional Oncology service (PIO) which is a multidisciplinary team with expertise in a variety of interventional oncology techniques and in treating pediatric cancers such as bone and soft tissue sarcomas, hepatic tumors, osteosarcoma, liver tumors, and retinoblastoma. This enables us to provide the most effective and innovative treatments to our patients while minimizing long-term side effects.
- Raja Shaikh, MBBS, MD - Interventional Radiologist
- Allison F. O'Neill, MD - Oncologist
- Lisa R. Diller, MD - Oncologist
- Katherine A. Janeway, MD - Oncologist
- Rush Chewning, MD - Interventional Radiologist
- Darren Orbach, MD, PhD - Neurointerventional Radiologist
- Pamela Sanborn, MS, CPNP, FNPC (IR)
Members of the interventional radiology team are continually seeking to advance cancer research and translate lab findings into more effective treatments. Their current research includes:
- Developing a registry of pediatric patients with relapsed or refractory solid tumors undergoing interventional radiology procedures in order to assess the efficacy of the procedures and the impact on quality of life and overall survival.
- Creating a Biobank, which will offer access to samples and data that will enable additional research studies to identify more effective and better-tolerated therapies for patients with pediatric solid tumors.
- Evaluating the use of percutaneous core needle biopsy in the diagnosis of pediatric solid tumor patients.