INTERVENTIONAL ONCOLOGY – THE FOURTH PILLAR OF CANCER CARE

Dr. Abhishek Bansal
Consultant, Interventional Oncology
Rajiv Gandhi Cancer Institute and Research Centre, Delhi

“There is no time like the present”. This phrase cannot be more apt than writing an article to create awareness about Interventional Oncology (IO) – the newest/ minimally invasive and one of the most advanced and exciting branches of medicine, which is changing the lives of cancer patients across the globe. October 25-31 is celebrated as the IO Awareness Week to increase awareness about this field and its benefits for cancer patients.

IO is an emerging subspecialty of interventional radiology that “uses image-guided procedures to enhance cancer care,” according to a recent paper published in The Oncologist.1 The combination of skill sets of Interventional procedures and Radiological knowledge helps the Interventional Radiologists to reach the most difficult parts of the body in a minimally invasive manner, thus improving the accuracy of the procedure and at the same time reducing the risks and complications associated with such procedures. The application of such advanced procedures into the field of oncology have led to the development and tremendous growth of this field called as the- Interventional Oncology (IO).

IO has advanced over the past few years as improved hardware, imaging technologies and new procedures are being developed. IO aims at using minimally invasive techniques to diagnose (providing a tissue for diagnosis of the smallest lesions in the body) or treat tumours (like radiofrequency ablation (RFA) / microwave ablation (MWA)/ cryoablation of tumours, thorough which the tumours are killed by heating/ cooling with only a thin needle without the need of a surgery). Liver cancer can be treated effectively through minimally invasive angiographic procedures such as Trans-arterial chemoembolization (TACE) or (Trans-arterial Radioembolization) in which drugs or radioactive particles are injected directly into the tumour cells without any major systemic side effects.

Cancer is associated with a lot of problems for the patients, bleeding from cancer is one of the major one which could be even life threatening. A major role of IO is stoppage of these cancer related bleedings by stopping the abnormal blood vessels which supply these tumours, all through fine needles, catheters and wires combination. The importance of palliative care cannot be over-emphasized and IO plays a critical role in providing palliative care to cancer patients in the form of pain relief, mitigation of cancer related symptoms and end of life care.

The role of IO in the management of cancer has been growing and has now established itself as the fourth pillar of Modern Oncology care” (the other three being medical, surgical, and radiation), as is evident by its increasing role in cancer treatment guidelines.Most of the IO procedures require only local anesthesia or mild sedation and the patient can be discharged the next day.

A lot of patients with Gall bladder and Bile ducts cancer develop jaundice due to obstruction by the tumour. A major role of IO is opening up these bile ducts and placing stents in them so that the patient is relieved of jaundice and can go for further treatment of the cancer. This has drastically changed the lives of patients suffering from these cancers who otherwise used to suffer a lot without cancer related treatment in the presence of jaundice.

Fig 1.Interventional oncology plays a key role in integrated cancer care is part of the four pillars of cancer care: medical oncology, surgical oncology, radiation oncology, and interventional oncology.1

A more patient centered and personalized treatment approaches has also led to further development of IO.2IO is focused on three main areas in cancer management: diagnosis, therapy, and symptom palliation.1 A major advantage of IO is localized effect on the tumor or a single organ in the body with minimal systemic side effects.3 Numerous studies have shown that cancer patients treated in multidisciplinary environments benefit greatly from the combined expertise. Interventional Radiologists are seen as playing a major role in multidisciplinary cancer teams where they provide innovative solutions to improve combined therapies and to treat complications.4 IO has evolved in the treatment of liver malignancies, both primary and secondary in the form of liver directed therapies including chemoembolization/ radioembolization and ablative therapies as described above. The ablative therapies have further advanced with increasing role in lung, kidney and bone neoplasms as well.

Over the past few years, as the scope of IO has expanded, many big hospitals across the world are establishing subdivisions of IO. My institute, Rajiv Gandhi Cancer Institute & Research Centre (RGCI & RC) has also established the sub-division of IO in January 2021 and we are providing services to the hospital round the clock with an exclusive IO Cath Lab. The Society of Interventional Oncology (SIO) is a global non-profit association that supports and promotes the field of IO and we were associated with this global society for the launch of IO at our institute.

As we move into the era of Artificial intelligence and robotic technologies, the scope and utility of IO is only going to increase further.

  1. Schoenberg, S.O., Attenberger, U.I., Solomon, S.B. and Weissleder, R.. Developing a Roadmap for Interventional Oncology. The Oncol. 2018: 23: 1162-70.
  2. Bapst, Blanche & Lagadec, Matthieu & Breguet, Romain &Vilgrain, Valérie &Ronot, Maxime. Cone Beam Computed Tomography (CBCT) in the Field of Interventional Oncology of the Liver. Cardiovasc InterventRadiol. 2015. 38: 1180-6.
  3. Helmberger. Interventional Oncology – where are we now? – And where we should head for? Radiología (English Edition). 2019. 61: 1-3.
  4. Adam, Andreas; Kenny, Lizbeth M. “Interventional oncology in multidisciplinary cancer treatment in the 21st century”. Nature Reviews Clinical Oncology. 2015: 12(2): 105–13.

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