Interventional Radiology Treatments
Arterial Embolization with Radiation or Chemotherapy
Used to target tumors more directly from the inside of the liver or pancreas. Embolization is a well-established interventional radiology technique that is used to treat trauma victims with massive bleeding, to control hemorrhage after childbirth, to decrease blood loss prior to surgery and to treat tumors. In treating cancer patients, interventional radiologists use embolization to cut off the blood supply to the tumor (embolization), deliver radiation to a tumor (radioembolization), or combine this technique with chemotherapy to deliver the cancer drug directly to the tumor (chemoembolization).
Radiofrequency Ablation (RFA) offers a localized treatment that kills the tumor cells with heat, while sparing the healthy liver tissue. Thus, this treatment is much easier on the patient than systemic therapy. Radiofrequency energy can be given without affecting the patient's overall health and most people can resume their usual activities in a few days. RFA can be used for multiple tumors and can be performed by an interventional radiologist using non-surgical techniques (directly through the skin with X-ray guidance) or by a surgeon (through a laparascope or a traditional surgical incision). A small needle is guided into the tumor. From the tip of the needle, radiofrequency energy (similar to microwaves) is transmitted to the tip of the needle, where it produces heat in the tissues. The dead tumor tissue shrinks and slowly forms a scar. The FDA has approved RFA for the treatment of liver tumors.
Complex Biliary Drainage
Usually performed by an interventional radiologist with the help of X-ray guidance. Drains are placed to improve bile drainage that has been compromised by benign or malignant tumors. In some patients, such as those with liver cancer or individuals who have had an injury to the liver, the bile ducts become blocked and bile cannot drain from the liver. The interventional radiologist places a catheter through the skin and into the bile ducts to drain the bile. In some cases, a small metal cylinder, called a stent, is placed in the liver to hold the blocked area open. A catheter may also be placed to drain bile in patients.
TIPS or Transjugular Intrahepatic Portosystemic Shunt
Seen most frequently in patients with liver disease such as cirrhosis or hepatitis, portal hypertension is a condition in which the normal flow of blood through the liver is slowed or blocked by scarring or other damage. Patients with the condition are at risk of internal bleeding or other life-threatening complications.
Interventional radiologists treat portal hypertension without surgery, using a procedure called TIPS (transjugular intrahepatic portosystemic shunt). The doctor threads a catheter through a small incision in the skin near the neck and guides it to the blocked blood vessels in the liver. Under X-ray guidance, the doctor creates a tunnel in the liver through which the blocked blood can flow. The tunnel is held open by the insertion of a small metal cylinder, called a stent.
A minimally invasive treatment for liver cancer that can be used when there is too much tumor to treat with radiofrequency ablation (RFA), when the tumor is in a location that cannot be treated with RFA, or in combination with RFA or other treatments. Chemoembolization delivers a high dose of cancer-killing drug (chemotherapy) directly to the organ while depriving the tumor of its blood supply by blocking, or embolizing, the arteries feeding the tumor.
Using imaging for guidance, an interventional radiologist threads a tiny catheter up the femoral artery in the groin into the blood vessels supplying the liver tumor. The embolic agents keep the chemotherapy drug in the tumor by blocking the flow to other areas of the body. This allows for a higher dose of chemotherapy drug to be used, because less of the drug is able to circulate to the healthy cells in the body. Chemoembolization usually involves a hospital stay of two to four days. Patients typically have lower than normal energy levels for about a month afterwards.
Chemoembolization is a palliative, not a curative, treatment. It can be extremely effective in treating primary liver cancers, especially when combined with other therapies. It has shown promising early results with some types of metastatic tumors. Although the individual materials used in this treatment are FDA approved, the treatment itself is not approved for intra-arterial therapy of liver tumors.