Interventional Oncology

Interventional oncology 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 located in various organs of the human body. Interventional oncology treatments are routinely carried out by interventional radiologists in appropriate settings and facilities.

Embolisation

Embolisation is a non surgical, minimally invasive procedure in which the blood vessels are plugged with a type of glue to stop the flow of blood to an area in the body/ a tumour so that it eventually becomes necrotic or shrinks the tumour. Under x-ray a catheter is guided from the main artery in the leg up into the area that is to be treated. This is repeated for each vessel that feeds the tumour. NET Patients can often require this procedure to be repeated and so this method is frequently combined with multi modality treatment for NETS.

The embolisation procedure is carried out by a consultant radiologist who would have completed advanced post residency training in interventional radiology. It is most common for patients to have embolisation with little or no sedation, although this depends on the organ that is to be targeted.

A guide wire and catheter is carefully inserted into a suitable artery and guided to the area in question with the help of live images /digital subtraction angiography (DSA) so that the Radiologist can gain access to the correct vessel(s). Once the ‘glue’ is inserted another set of DSA images are taken.

TACE – transcatherter Arterial Chemoembolisation

Just like embolisation TACE is a minimally invasive procedure to restrict a tumor’s blood supply using a chemotherapeutic dose directed at the tumour rather than ‘glue’ as above. Again the radiologist would use the same process as above (embolisation) and when the most appropriate blood vessel supplying tumor has been chosen the chemotherapy dose /drug is injected through the catheter. This dose may be given in one vessel or alternatively it can be divided among several vessels that are supplying the tumor(s).

Patients are routinely kept in a hospital for one to two days following the procedure just in case inflammatory chemicals find their way into the blood stream.

RFA – Radio Frequency Ablation

RFA is a medical procedure whereby heat made by radio waves are used to kill cancer cells. This electrical current, heats the cancer cells to a point where the tumours are destroyed. Your doctor/consultant may recommend RFA because you may have several tumours or the position of the cancer in your body means that it would be very difficult for a surgeon to do e.g. if it is near a major blood vessel or if you are unable to have a general anesthetic.

First you are given a general anaesthetic (for a large area) or a sedative with a local anaesthetic to numb the area before a probe is inserted through your skin into the tumour itself. You can also have RFA during surgery/laparoscopy and timings can vary however, it usually takes about 30 minutes to treat one tumour.

Pain or discomfort in the treatment area and generally feeling unwell with high temperatures are a common side effect of RFA which you may have for a few days after treatment. Your doctor or specialist nurse will give you painkillers to take home with you and then you will usually be given a follow up appointment for a scan to show how well the procedure has worked.

MWA – Microwave Ablation

Microwave ablation is a procedure that uses heat from microwave energy to destroy cancer cells. MWA is used to treat cancer that has spread to the liver from other parts of the body. As with RFA this procedure can be performed during:

• Open Surgery
• Laparoscopic Surgery
• By needle through the skin.

Sirtex – SIR-Spheres microspheres

SIR-Spheres microspheres are an innovative means of treating liver cancer. In cases where it is not possible to surgically remove the liver tumours, SIR-Spheres microspheres can be used to deliver targeted, internal irradiation therapy directly to the tumour. This new therapy is called Selective Internal Radiation Therapy also know as SIRT. This technique uses millions of tiny resin microspheres which contain a radioactive element called yttrium-90. SIR-Spheres microspheres are very small, approximately 32 microns in size. A specially trained physician known as an interventional radiologist usually administers sIR-Spheres microspheres as an inpatient procedure. A small catheter is guided into the liver and the SIR-Spheres microspheres are infused through the catheter. The microspheres with the radioactive yttrium-90 are carried by the bloodstream directly to the tumours in the liver where they preferentially lodge in the small vssels feeding the tumour and deliver their dose of radiation. Unlike conventional external beam radiation, which can only be applied to limited areas of the body, SIR-Spheres microspheres selectively irradiate the tumours and therefore have the ability to deliver more potent doses of radiation directly to the cancer cells over a longer period of time.

TheraSphere™ Y90 Microspheres: A Targeted Treatment for Liver Cancer:

TheraSphere™ Y90 microspheres offer an effective and targeted therapy for liver cancers by leveraging the abundant blood supply to tumours. This enables focused radiation delivery directly to the tumour while safeguarding healthy tissue. Thanks to the highest specific activity for each microspheres, fewer are required to deliver an high dose to the tumour, preserving healthy liver parenchyma. With each microsphere possessing high activity, fewer are required, reducing risks and preserving liver vasculature. TheraSphere™ can be tailored to each patient’s needs with various dosing options, ensuring flexibility in treatment aligned with individual goals and conditions.

Clinical studies demonstrate TheraSphere™’ efficacy across diverse liver cancer types, including hepatocellular carcinoma (HCC) with single or multiple tumours, and those complicated by portal vein thrombosis (PVT). It caters to both localized and broader liver regions.Key studies like DOSISPHERE-01 and LEGACY underscore significant improvements in patient survival and sustained tumour control through personalized TheraSphere™ dosing. The RASER study even indicated a 100% initial response rate in early-stage HCC cases, suggesting a potential curative avenue. Additionally, the EPOCH trial affirmed Therasphere combined with systemic treatment as a second-line therapy for patients presenting with liver metastases originating from primary colon cancer, TheraSphere™’ value as a second-line therapy for liver cancer originating from the colon, reducing the risk of disease and liver progression enhancing progression-free intervals and response rates without compromising quality of life or introducing undue side effects.

A comprehensive real-world retrospective study confirmed TheraSphere™’ predictable clinical outcomes across a wide patient demographic in eight countries. The TARGET study, alongside DOSISPHERE-01 and LEGACY trials, accentuated the importance of delivering the maximum safe dose to the tumour to optimize patient response and survival. Predictable outcomes were facilitated by Simplicit90Y personalized dosimetry software, employing multi-compartmental dosimetry for precision.

Recently promising interim data from PROACTIF, the largest, prospective, multicenter, post-approval, real-world study of the use of Y-90 Therasphere to treat patients with primary liver cancer, demonstrated prolonged OS for patients with locally intermediate-advanced HCC with portal vein thrombosis. This data set adds to the growing body of evidence that supports the use of TheraSphere for patients with HCC.

Endorsed by the National Institute for Health and Care Excellence (NICE) for treating HCC, metastatic colorectal cancer (mCRC), and neuroendocrine tumours (NETs), TheraSphere™ Y90 glass microspheres offer a proven, adaptable solution for enhancing outcomes in liver cancer patients.

Oncosil

OncoSil™ is a single-use brachytherapy (internal radiation) device used to deliver a pre-determined dose of beta radiation directly into cancerous tissue. OncoSil™ carries the active component radioactive Phosphorous (P-32) microparticles. These microparticles are tiny, and range in diameter from 28 to 32 micrometres, which is smaller than the width of a human hair.  Once implanted, the OncoSil™ microparticles will remain permanently in your tumour.

How does OncoSil™ work?

OncoSil™ is injected directly into the pancreatic tumour under endoscopic ultrasound image guidance.  The purpose of the OncoSil™ device is to deliver radiation from Phosphorous-32 (P-32) directly into your tumour to destroy cancer cells.  Once implanted, 98% of the radiation will be delivered in 81 days and the OncoSil™ microparticles will remain permanently in your tumour; they have been tested to ensure long-term safety.  The beta radiation emitted by the OncoSil™ travels a short distance to the tumour tissue causing direct damage to the cancer cell DNA.  This damage makes the cancer cells incapable of further cell division and proliferation.  By stopping cell division and proliferation, OncoSil™ can prevent the cancer cells from multiplying and may ultimately shrink the tumour mass as the cancer cells eventually die.

Who is OncoSil™ suitable for?

OncoSil™ is intended for the treatment of patients with locally advanced unresectable pancreatic cancer, in combination with gemcitabine-based chemotherapy.

University Hospital Southampton is currently recruiting for a trial to assess the safety and efficacy of OncoSil™ when given in addition to standard FOLFIRINOX chemotherapy for treatment of Locally Advanced Pancreatic Cancer.

For trial details and patient eligibility details, click here.

Click here to read the oncosil-patient-guide