The most common interventional radiology procedures performed at Roswell Park include:
- Ablation, including microwave ablation and irreversible electroporation
- Liver tumor embolization, including radioembolization, chemoembolization and bland embolization
- Thoracic duct embolization
- Uterine fibroid embolization
- Radial access
- IVC filter placement/retrieval
- Percutaneous biliary drainage/stenting
- Urinary tract interventions
- Venous access, including placement of chest ports, peripherally inserted central catheters and pheresis catheters
In ablative therapy, a probe is inserted directly into the tumor. Energy is passed through the probe, heating or freezing the tumor cells until they are destroyed, without damaging healthy tissue around the tumor. Ablation is an outpatient, same-day procedure done under conscious sedation, and it is much less invasive than surgery.
Roswell Park offers these types of ablation therapy:
- Microwave ablation uses extreme heat to destroy tumors. This approach is used to treat small tumors in the lung, liver, and kidney.
- Cryoablation uses cold to freeze the tumor and is typically used to in treatment of kidney or skin cancers.
- NanoKnife irreversible electroporation uses electrical currents to kill tumor cells while sparing vital structures nearby. NanoKnife is used to treat liver and pancreatic cancers.
Getting a quality biopsy is critical in order for the pathologist to determine the exact cancer type, grade and other characteristics that guide treatment decisions.
Roswell Park’s oncology-focused interventional radiologists perform biopsies using CT or ultrasound guidance. We use small needles to access the target area with a minimal incision, preventing the need for more invasive surgical biopsies. These are performed as same-day procedures with either conscious sedation or local anesthesia.
Embolization has relatively few side effects because the anticancer agents, such as chemotherapy drugs or radioactive particles are directed to the tumor and don’t travel throughout the body. Since it’s not as toxic as external beam radiation or systemic chemotherapy, embolization can be used when other treatments have failed without decreasing a person’s quality of life.
Roswell Park offers these embolization procedures:
- Radioembolization (also called Selective Internal Radiotherapy-SIRT and Transarterial Radioembolization-TARE). Tiny particles (SIR Spheres or Theraspheres) containing yttrium (y90), a radioactive isotope that kills cancer cells, are injected into the artery supplying the tumor. This type of embolization is used predominantly for treating liver cancer (hepatocellular carcinoma and cholangiocarcinoma) and metastatic colon cancer. This procedure usually involves two steps. First, mapping angiogram is performed to map out the anatomy of the tumor and calculate the dose of radiation necessary. Then, treatment is delivered in one or two sessions. All of these procedures are same day procedures.
- Transarterial Chemoembolization (TACE). Tiny particles containing chemotherapy drugs are injected into the artery supplying the tumor. These particles pack a one-two punch, blocking blood flow to the tumor while releasing anti-cancer drugs. This type of treatment not only allows a higher amount of the drug to reach the tumor for a longer period of time but also decreases the side effects of chemotherapy, as the drug is directed to the tumor and doesn’t have to circulate throughout the body in order to be effective. Chemoembolization is predominantly used to treat liver cancer (hepatocellular carcinoma). Patients typically require an overnight hospital stay and most are discharged the day after the procedure.
- Bland embolization uses small particles to cut off the blood supply to liver tumors to prevent them from growing. Bland embolization can be used in conjunction with other treatments, such as chemotherapy. This embolization procedure treats primary liver tumors or other cancers that have metastasized to the liver, such liver metastases from neuroendocrine carcinoma. Patients typically require an overnight hospital stay and most patients are discharged the day after the procedure.
Radial (Wrist) access embolization uses the wrist rather than the groin as an access point to a large artery. Traditionally, embolization procedures are performed by accessing the femoral artery in the groin which allows access to the arteries supplying the tumor in the liver. The downside of this approach is that patients must be immobilized for 2-4 hours after the procedure to allow the tiny hole made in the artery to heal.
We now can perform the procedure through the artery in the wrist (radial artery). This means we can perform the same procedure and afterwards a small band is placed on the wrist and the patient has free mobility instead of required bedrest.
The thoracic duct is the main lymphatic channel in the body. Thoracic surgery may impair this duct, resulting in lymphatic fluid leaking into the chest or abdomen. Interventional radiologists can close this leak with an embolization procedure. The radiologist accesses lymph nodes in the groin to reach the thoracic duct in the abdomen. The duct is embolized with tiny coils and medical glue.
Uterine fibroids are benign tumors of the uterus which can cause significant pain and discomfort. Uterine fibroid embolization is a minimally invasive procedure which can be performed through the artery in the wrist or groin to block the blood supply to these tumors, and help relieve their symptoms.
Selective Internal Radiotherapy (SIRT) combines radiotherapy with embolization. This treatment is also known as radioembolization or transarterial radioembolization (TARE). In this therapy, a catheter is inserted in the artery that leads to the tumor. Radioactive microbeads (SIR Spheres or Theraspheres) containing yttrium (y90), a radioactive isotope that kills cancer cells, are released through the catheter and delivered directly to the tumor. This ensures that the radiation dose is concentrated in the tumor, where the beads collect, and very little radiation reaches adjacent tissue. In addition, the microbeads block the blood flow to the tumor.
This type of embolization is used predominantly for treating liver cancer (hepatocellular carcinoma and cholangiocarcinoma) and metastatic colon cancer. This procedure usually involves two steps. First, mapping angiogram is performed to map out the anatomy of the tumor and calculate the dose of radiation necessary. Then, treatment is delivered in one or two sessions. All of these procedures are same-day procedures.
Compared to external beam radiotherapy, SIRT can deliver higher doses of radiation to the tumor with fewer side effects to nearby tissues and organs. This treatment fights cancer in two ways, by killing the cancer cells with radiation, and by destroying the blood vessels that feed the tumor.
An inferior vena cava (IVC) filter is used to prevent blood clots from reaching the lungs, preventing a potentially life-threatening condition known as pulmonary embolism. Typically, these filters are inserted in the inferior vena cava, the large vein in the abdomen that brings blood from the lower body back to the heart, to stop blood clots traveling from the legs. Modern IVC filters are designed to be removed when a patient is no longer at risk for pulmonary embolism.
Placement of an IVC filter is for patients who have blood clots but cannot be on medicine to thin their blood.
Removal of the IVC filter is typically a same-day procedure and is performed through the same neck vein the filter was placed.
Percutaneous Biliary Drain/Stent The liver drains bile into the bowel to help process food. Your body accomplishes this through a network of bile ducts which coalesce into a main duct called the common bile duct. If a tumor compresses the bile ducts, such as may occur in pancreatic cancer or cholangiocarcinoma, it becomes necessary to relieve the obstruction by placing a drain or stent (a tiny tube) to hold the duct open.
To place a biliary drain or stent, an interventional radiologist inserts a small needle into the liver and injects contrast (dye) to identify the bile ducts. Then a wire is passed into the duct to navigate past the obstructed area and place the drain. In patients with advanced pancreatic cancer, this drain can then be used as access to place a permanent stent.
Interventional radiologists perform procedures to relieve urinary obstruction, a complication that may result from bladder cancer surgery. We can place nephrostomy tubes in the kidney to divert the flow of urine around the obstruction. Later, these may be converted to internal ureteral stents which can be changed routinely by the patient’s urology physicians.
Venous Access Procedures Many cancer treatments, such as chemotherapy, cellular therapy and others, must be infused into the blood, and require frequent and long-term access to the bloodstream. To provide better and safer access for these treatments, interventional radiologists may place one or more of these:
- Peripherally inserted central catheter (PICC)
- Chest port
- Pheresis catheter