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Interventional Radiology Clinic |
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Cancer
Treatment
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Minimally Invasive Ways to Live with Cancer. Therapies For Incurable Disease Palliative Treatment of metastatic cancer has the goal of improving quality and length of life while minimizing side effects of the treatment and disease itself. High blood pressure, heart disease, diabetes are examples of chronic illnesses that generally are not curable. These diseases are mangaged over a long period of time with medical and surgical therapy aimed at decreasing their negative side-effects and avoiding life-threatening complications. Incurable cancer can be approached in a similar fashion. Metastatic Disease Many incurable cancers are classified as such because the have spread (metastasized) to other parts of the body before being discovered. Local spread or minimal distant spread of cancer can usually be treated or even cured with surgery and systemic chemotherapy. When the number or location of the metastatises prevents their safe surgical removal systemic chemotherapy has a more difficult task to accomplish. Local tumor ablation and regional chemotherapy are two techniques commonly employed in these cases. Tumor ablation allows destruction of cancer cells that cannot be physically removed. Regional chemotherapy allows high doses of medication to be delivered to the cancer while avoiding some of the side-effects of high dose systemic therapy. Local Tumor Ablation techniques are designed to destroy tumor cells in places that cannot be removed surgically. The most common organ where this technique is employed is the liver. Kidney, bone and lung are other locations where these techniques have been used. In general any method that is toxic to tissue cells can be employed: heat, cold and chemical techniques are common. While generally not as good as surgical removal, local tumor ablation (particularly when combined with systemic or regional chemotherapy) can give effective palliative results. Percutaneous Ethanol Injection: Ethyl alcohol is used as a topical antiseptic because it kills cells on contact. When injected into soft-tissue tumors it kills cells on contact and can be used just about anywhere in the body approachable by a small caliber needle. It is cheap, technically straight-forward and generally safe to use with few side-effects. While effective, it does not generally completely destroy the tumor treated and other techniques are usually favored. Another agent, acetic acid, can be used with better results but higher toxic side effects. Radio-Frequency Ablation: Also referred to as RFA, kills tumor cells with heat delivered from radiowave agitation of the cells. A relatively large needle containing multiple tines is placed inside the tumor. These tines are then deployed into the peripheral portions of the tumor and connected to a radiowave generator. Very much the same way a radiotransmitter is connected to an antenna to broadcast your local AM radio show. While the tumor cells don't hear music they do begin to vibrate during the broadcast. This vibration generates heat which rises high enough to kill the tumor cells. RFA is generally felt to be more effective than ethanol injection of liver tumors and is preferred as the treatment of choice whenever possible. Regional Tumor Ablation techniques. These techniques are aimed at patients that have multi-focal disease that cannot be treated with surgical resection or RFA. Internal Radiation Therapy: Internal Radiation Therapy refers to the placement of tiny (35 micron) radioactive spheres into the blood supply to the liver to treat liver metasteses. Currently we are using Yttrium-90 labeled microspheres (Sirtex Medical). This is a new therapy (FDA Approved) that allows that application of radiation therapy to treat generalized liver metastases that could not be treated previously with external beam therapy because of the risk of radiation hepatitis and liver failure. This new therapy takes advantage of the generally increased blood flow to the tumor deposits within the liver to spare the normal tissue receiving fatal doses of radiation. The technique has FDA apporval for use in colon cancer metastatic to liver (with intraarterial chemotherapy) and has been used to treat other liver cancers like hepatocellular carcinoma, metastatic breast, adenocarcinoma, melanoma and carcinoid tumors. More info. Transarterial Chemo-embolization: Also referred to as TACE. Chemotherapy is delivered directly to the tumor deposits within the liver. This is done during a procedure called an angiogram. Angiography refers to the placement of catheters inside the blood vessels. These catheters are followed using a fluoroscope and directed into the arteries that feed the liver and then into the vessels feeding the liver tumors. Chemotherapeutic drugs are mixed with agents that trap the drug inside the liver/tumor prolonging its contact time with the tumor and cutting off the tumor's blood supply in one step. This enhaces the effect of the chemotherapy allowing lower doses to be used and sparing the patient some of the side-effects of systemic chemotherapy. Interventional Radiology Clinic South Texas Radiology Group General Contact: 210 616-7780 Affiliated Hospitals Where the Procedure Can be Performed Methodist Specialty and Transplant
Hospital 210 575-8155 Radiology Southwest Texas Methodist Hospital |
