Interventional oncology Tze Wah a , David Breen b , Jai Patel a , Tony Nicholson a, * a Leeds Teaching Hospitals, NHS Trust, UK b Southampton General Hospital, UK article info Article history: Available online 11 December 2011 Keywords: Interventional Oncology Ablation Renal cancer Liver cancer abstract Interventional Oncology is a relatively new term that has been used to describe the practice of minimally invasive percutaneous cancer treatment. It has been used for palliative and adjuvant treatments to improve quality of life for some forty years. Curative interventions or interventions which extend life significantly, require ablative techniques i.e. techniques that destroy tumour mass either completely or sufficiently to reduce the tumour load. This review describes the state of the art in liver and renal ablation and liver chemotherapy and isotope embolisation. Such ablative techniques are increasingly being used in other cancer treatments such as the lung, prostate and perhaps in future the breast. Ó 2011 Published by Elsevier Ltd on behalf of The College of Radiographers. Introduction The increasing importance of percutaneous ablative techniques was the driver behind the term interventional oncology but, in truth, interventional radiologists had been treating cancers since the earliest days of the subspecialty. The occlusion of blood supply to tumour, embolisation or embolotherapy, was well described by numerous authors by 1975, 1 usually to treat tumour haemorrhage, as was the direct intra-arterial administration of chemotherapy. 2 The introduction of stents in the late 1980’s saw the development of percutaneous palliative cancer treatments for pancreatic and biliary cancer 3 and later for oesophageal and rectal cancers. 4 The devastating symptoms of cancer induced superior and inferior vena cava obstruction can be almost instantaneously relieved by vena cava stenting 5 and preoperative embolisation of tumour blood supply is used extensively to negate the serious mortality and morbidity caused by intra-operative bleeding. 6 However these are mainly palliative or adjuvant treatments that improve the quality of fading lives, like the majority of chemo- therapeutic and some radiation treatments. Curative interventions or interventions which extend life significantly, require ablative techniques i.e. techniques that destroy tumour mass either completely or sufficiently to reduce the tumour load. This review will therefore concentrate on ablative techniques, describing the state of the art in liver and renal ablation and liver chemo and isotope embolisation. Such ablative techniques are increasingly being used in other cancer treatments such as the lung, prostate and perhaps in future the breast. Liver tumour ablation Improvements in cross-sectional imaging in recent years have driven the increasing detection of small volume, ‘subclinical’ disease, and nowhere is this more evident than in the liver. The multidisciplinary team (MDT) is increasingly faced with the older patient under follow-up for colorectal cancer with small volume metastatic disease or the cirrhotic patient under surveillance with a new small hepatocellular carcinoma. Image guided tumour ablation was first performed in the liver in the early 1990’s, an acknowledgment of the fact that major liver resection e in partic- ular for small volume disease e is a major undertaking for patient and surgeon alike. Effective liver tumour ablation requires an understanding of the devices currently on the market, effective image-guidance and an appreciation of the pathophysiology of the disease and the background organ environment. Thermal ablation began with monopolar radiofrequency abla- tion (RFA) in the early 1990’s. In essence this is an open ‘circuit’ operating a ‘radiofrequency’ with grounding pads attached to the patient and the resulting current flux centred around the exposed monopolar tip of the probe which causes lethal tissue heating. Unfortunately, early reports yielded small and poorly predictable volumes of tissue destruction. The manufacturers set about improving probe effectiveness by creating expandable, ‘multi- tined’ and even multipolar probes. These now yield reliable 4 þ cm diameter spheres of tissue destruction. More recently microwave (MWA) probes have been developed which appear to produce * Corresponding author. Radiology Department, Leeds General Infirmary, Leeds LS13EX, UK. Tel.: þ44 (0) 1133922860. E-mail address: tony.nicholson@leedsth.nhs.uk (T. Nicholson). Contents lists available at SciVerse ScienceDirect Radiography journal homepage: www.elsevier.com/locate/radi 1078-8174/$ e see front matter Ó 2011 Published by Elsevier Ltd on behalf of The College of Radiographers. doi:10.1016/j.radi.2011.10.001 Radiography 18 (2012) 15e20