Interventional oncology (abbreviated IO) is a subspecialty field of interventional radiology that deals with the diagnosis and treatment of cancer and cancer-related problems using targeted minimally invasive procedures performed under image guidance. Interventional oncology has developed to a separate pillar of modern oncology and it employs X-ray, ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) to help guide miniaturized instruments (e.g. biopsy needles, ablation electrodes, intravascular catheters) to allow targeted and precise treatment of solid tumours (also known as neoplasms) located in various organs of the human body, including but not limited to the liver, kidneys, lungs, and bones. Interventional oncology treatments are routinely carried out by interventional radiologists in appropriate settings and facilities.
Procedures performed Interventional oncology procedures are generally divided between diagnostic procedures that help obtain tissue diagnosis of suspicious neoplasms and therapeutic ones that aim to cure or palliate the tumour. Therapeutic interventional oncology procedures may be classified further into ablation techniques that destroy neoplastic tissues by delivery of some form of heat, cryo or electromagnetic energy and embolization techniques that aim to occlude the blood vessels feeding the tumour and thereby destroy it by means of ischemia. Both ablation and embolization techniques are minimally invasive treatment, i.e. they may be delivered through the skin (in a percutaneous way) without the need for any skin incisions or other form of open surgery. Hence, most treatments are nowadays offered as day case or outpatient appointments and patients may enjoy rapid recovery and minimal pain and discomfort with low rates of complications.
Diagnostic techniques Fine-needle aspiration: biopsy with a fine needle trying to obtain tissue diagnosis by examining the tumour cells. Core needle biopsy: similar to fine-needle aspiration, only involving the use of larger needles to excise the tissue. Vacuum-assisted biopsy: similar to core needle aspiration but using vacuum assistance to gather the sample. Vacuum assisted breast biopsy may provide a high diagnostic yield in case of breast tumours.
Image-guided tumor ablation Uses different types of energy to burn (radiofrequency ablation (RFA) and microwave ablation (MWA)), deliver electrical fields/electroporate (irreversible electroporation(IRE)) or freeze (cryoablation) solid tumors resulting in tumor cell death. Ablation techniques can be performed throughout the body such as in the lung, liver, kidney, prostate, breast, bone, and other organs using image guidance to place a needle/probe through the skin into the target tissue.
Chemical ablation: one of the earliest ablative techniques involving the injection of substances such as ethanol or acetic acid into a tumour to cause protein denaturation and cell death. Radiofrequency ablation: tissue destruction through delivery of electricity that produces ionic friction. Radiofrequency ablation video demonstration: https://www.youtube.com/watch?v=8Xu0mxkLSzE Irreversible electroporation: delivery of electrical fields to disrupt cellular membranes and cause cell death or apoptosis or enhance targeted drug delivery. Irreversible electroporation video demonstration: https://www.youtube.com/watch?v=NL-IIq-c3Ic Cryoablation: instant cell death by tissue freezing to temperatures as low as -20 Celsius. Cryoablation video demonstration: https://www.youtube.com/watch?v=goLRh3UX0vM Microwave ablation: electromagnetic energy produces high frequency oscillation of water molecules leading to tissue coagulation by heat. Microwave ablation video demonstration: https://www.youtube.com/watch?v=uPcU7HFumIk High-intensity focused ultrasound (HIFU): targeted beam of focused ultrasonic waves that accumulates high energy and burns the tissue. Laser ablation (Interstitial laser therapy): tissue coagulation by a laser beam.
High-intensity focused ultrasound (HIFU) Uses a machine that emits high frequency sound waves to kill cancer cells and provide relief for tumor-related pain, such as in the bone.
Embolisation therapies Transarterial embolization (TAE)/bland embolization: Injection of embolic material (microparticles, alcohol, glue) through a catheter into the arteries feeding a tumor in order to completely occlude the tumor's blood supply and cause cell death. The most common indication is for treatment of unresectable liver cancer (hepatocellular carcinoma). Trans(catheter) arterial chemoembolization (TACE): Injection of a chemotherapy agent often with microparticles through a catheter into arteries feeding a tumor that both delivers chemotherapy and blocks the blood supply to the tumor to cause cell death Can be performed in different ways: Conventional transarterial chemoembolization (cTACE): Injection of lipiodol with high dose chemotherapy with or without microparticles directly into the tumor-feeding arteries. Drug-eluting bead chemoembolization (DEB-TACE): delivery of microparticles that are themselves loaded with the chemotherapy agent – typically doxorubicin or irinotecan. Selective internal radiation therapy (also known as SIRT or Y-90 radioembolization or TARE): Injection of small beads loaded with a radioactive isotope, Yittrium-90 (Y-90), into blood vessels feeding a tumor in order to deliver a lethal dose of radiation causing cell death. Can be performed in a segmental (radiation segmentectomy) or a lobar (Radiation Lobectomy) fashion. Radiation lobectomy is commonly performed with the goal of inducing growth of the non-diseased lobe in order to have adequate liver function necessary to undergo surgical resection. Y-90 video demonstration: https://www.youtube.com/watch?v=YndyQkSZl5I Intra-arterial chemotherapy: high dose chemotherapy is administered directly into the tumor-feeding arteries. Portal vein embolization (PVE): delivery of embolic material into the portal vein feeding the lobe of liver containing the tumor(s) of interest to induce growth of the non-diseased lobe in order to have adequate liver function necessary to undergo surgical resection of lobe containing the tumor(s).
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