Interventional Radiology Approaches Offer Alternative-to-Surgery Options
If you’ve undergone cancer treatment at Roswell Park and needed a mediport to deliver treatment and draw blood, you’ve probably met one of our interventional radiology physicians, even if you don’t remember them. However, liver cancer survivor Paul Switalski and his wife and caregiver Joanne, will never forget Roswell Park Interventional Radiologist Michael Petroziello, MD. In addition to being “the kindest doctor we’ve ever met,” Joanne says, “Dr. Petroziello performed three different kinds of minimally invasive procedures to treat Paul’s liver cancer, which allowed him to avoid having a liver transplant.” Those procedures are called intra-arterial or transarterial therapies, and they are a specialty of Roswell Park’s interventional radiology team.
What Is an Interventional Radiologist?
Interventional radiologists are specially trained physicians who use imaging technology and minimally-invasive techniques to diagnose — and treat — a variety of diseases, including tumors in the liver, lung and kidney, and fibroids in the uterus.
Using advanced medical imaging such as ultrasound and computed tomography (CT), interventional radiologists insert catheters into the patient, guiding them through the appropriate blood vessels to gain access to the veins (as in the case of a chest port or mediport), take a biopsy, or to intervene in a disease by delivering a therapy directly to a tumor via the arteries. These interventions, including embolization and ablation therapies, offer effective treatment options for certain tumor types.
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“Because these procedures use small incisions and precision targeting of tumors, many of the risks and side effects of major surgery and systemic chemotherapy are avoided, allowing for much quicker recovery,” explains Dr. Petroziello. The procedures may be used for several reasons, including to give a patient a break from systemic chemotherapy and to provide effective treatment for patients who cannot undergo major surgery or traditional chemotherapy.
When Paul was diagnosed with liver cancer in 2016, he was advised to undergo a liver transplant. “But there was no guarantee that a suitable liver would be available soon enough, and we couldn’t take the chance on waiting,” Joanne says. So, in collaboration with Paul’s Roswell Park oncologist, Dr. Petroziello performed a series of embolization and ablation procedures to treat Paul’s liver tumors.
What Is Transarterial Chemoembolization?
Embolization is a procedure in which tiny beads are injected into the artery that supplies blood to a tumor. The beads travel through the artery (transarterial) and collect at the tumor, blocking the blood supply and causing the tumor to shrink and die. In bland embolization, just the beads are used. In chemoembolization, the beads contain chemotherapy drugs.
“These chemo-soaked beads pack a one-two punch, blocking blood flow to the tumor while releasing anti-cancer drugs,” explains Dr. Petroziello. “This allows a higher amount of the drug to reach the tumor and for a longer period of time, but 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.”
What Is Radioembolization?
With radioembolization, the tiny beads contain yttrium (y90), a radioactive isotope that kills cancer cells. Radioembolization is also called Selective Internal Radiotherapy (SIRT) or Transarterial Radioembolization (TARE). This procedure usually involves two steps. First, a 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, under conscious sedation. “This is a same-day, outpatient procedure,” says Dr. Petroziello.
In Paul’s case, he first underwent chemoembolization, where the catheter was inserted into the femoral artery, via a small incision in the groin. However, Dr. Petroziello says that Roswell Park’s interventional radiologists now perform many procedures by inserting the catheter through the wrist instead. These radial wrist interventions heal more quickly and allow the patient free mobility afterwards, rather than the three to four hours of bed rest required after traditional groin access procedures.
Joanne recalls that while Paul experienced some discomfort at the incision site and some short-term nausea due to the chemotherapy, he needed only a single session of the chemoembolization.
What Is Ablation Therapy?
In ablation therapy, the interventional radiologist inserts a probe into a main artery, guiding it through the blood vessels to the tumor. Energy is passed through the probe, to destroy, or ablate, tumor tissue without damaging nearby healthy tissue. Ablation procedures may use extreme cold (cryoablation) or heat (thermal ablation) or electrical signals (NanoKnife ablation) to destroy the tumor. “Ablation is an outpatient, same-day procedure done under conscious sedation, and it is much less invasive than major surgery,” Dr. Petroziello explains.
Six weeks after Paul’s initial chemoembolization, a CT scan showed that the main tumor in Paul’s liver had been destroyed, but some smaller lesions were still present. The next step was to attack these with a session of thermal ablation followed by two sessions of radioembolization, each three months apart.
“Paul had very little discomfort during these procedures because the incisions were very small,” says Joanne. “And Dr. Petroziello could not have been more kind to us. He called us at home after each procedure to see how Paul was doing. He was always there to explain things to us whenever we had any questions. And most importantly, only eight months after being told he would need a liver transplant, scans, blood tests and liver function tests showed that Paul’s cancer was gone, and he no longer needs medications for his liver function. We just can’t say enough good things about the kind of specialized medical care that Dr. Petroziello and Roswell Park gave us.”
Editor’s Note: Cancer patient outcomes and experiences may vary, even for those with the same type of cancer. An individual patient’s story should not be used as a prediction of how another patient will respond to treatment. Roswell Park is transparent about the survival rates of our patients as compared to national standards, and provides this information, when available, within the cancer type sections of this website.