词条 | Interventional oncology |
释义 |
ApplicationsInterventional oncology procedures are commonly applied to treat primary or metastatic cancer. Interventional oncology may be offered once traditional surgery, chemotherapy or radiotherapy have failed or are not considered safe. IO treatments may be also offered in combination with any of the above oncological therapies in order to augment the therapeutic outcome in more complex or widespread (metastatic) cancer cases. There is an increase in the variety of applications of interventional oncological treatments for primary and metastatic cancer in different human body organs:
Milestones
ProceduresInterventional oncology procedures are generally divided between diagnostic procedures that help obtain tissue diagnosis of suspicious neoplasms and therapeutic ones that aim to cure or palliate the tumour. Therapeutic interventional oncology procedures may be classified further into ablation techniques that destroy neoplastic tissues by delivery of some form of heat, cryo or electromagnetic energy and embolization techniques that aim to occlude the blood vessels feeding the tumour and thereby destroy it by means of ischemia. Both ablation and embolization techniques are minimally invasive treatment, i.e. they may be delivered through the skin (in a percutaneous way) without the need for any skin incisions or other form of open surgery. Hence, most treatments are nowadays offered as day case or outpatient appointments and patients may enjoy rapid recovery and minimal pain and discomfort with low rates of complications.[11] Diagnostic techniques
Ablation techniques
Embolisation techniques
Palliative techniquesInterventional oncology has long been used to provide palliative care for patients. IO procedures can help reduce cancer-related pain and improve patients’ quality of life. Tumours can intrude into various ducts and blood vessels of the body, obstructing the vital passage of food, blood or waste. The interventional radiological treatment known as stenting can be used to re-open blockages, for example of the esophagus or bile ducts in cases of esophageal cancer or cholangiocarcinoma, respectively, considerably relieving the patient’s adverse symptoms.[17] BenefitsWhile the surgical resection of tumours is generally accepted to offer the best long-term solution, it is often not possible due the size, number or location of the tumour. IR therapies may be applied to shrink the tumour, making a surgical or interventional treatment possible. Some patient groups may also be too weak to undergo open surgery. IR treatments can be applied in these complex cases to provide effective and milder forms of treatment. Interventional oncological techniques can also be used in combination with other treatments to help increase their efficacy. For example, IO techniques can be used to shrink large tumours making them easier to excise. Chemotherapeutic drugs can also be administered intra-arterially, increasing their potency and removing the harsh effects of system-wide application. Patients can greatly benefit from IO treatments. The minimally invasive nature of the treatments means they cause less pain, fewer side effects and shorter recovery times. Many IO procedures can be performed on an outpatient basis, freeing up hospital beds and reducing costs.[18] Further considerationsMultidisciplinary approachCancer is a multifaceted disease group that requires a multidisciplinary approach to treatment. 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.[19] Patient selectionProper patient selection is the key element for the success of any medical procedure and improper conduct can have fatal consequences. Patient selection protocols must be strictly followed before treating patients with IO procedures. Radiation protectionIO treatments are carried out under image guidance. For this reason practitioners must have attained solid training in radiation protection. See alsoInterventional radiologyReferences1. ^Hickey R, Vouche M, Sze DY, et al. Cancer concepts and principles: primer for the interventional oncologist-part II. J Vasc Interv Radiol. 2013 Aug;24(8):1167-88. {{doi|10.1016/j.jvir.2013.04.023}}. 2. ^Hickey R, Vouche M, Sze DY, et al. Cancer concepts and principles: primer for the interventional oncologist-part I. J Vasc Interv Radiol. 2013 Aug;24(8):1157-64. {{doi|10.1016/j.jvir.2013.04.024}}. 3. ^1 Interventional Radiology Treatments for Liver Cancer. 4. ^1 Pereira PL, Masala S; Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Standards of practice: guidelines for thermal ablation of primary and secondary lung tumors. Cardiovasc Intervent Radiol. 2012 Apr;35(2):247-54. {{doi|10.1007/s00270-012-0340-1}}. 5. ^[https://www.rcr.ac.uk/interventional-oncology-guidance-service-delivery-0 The Royal College of Radiologists UK. Interventional Oncology: Guidance for Service delivery] 6. ^Katsanos K, Mailli L, Krokidis M, et al. Systematic review and meta-analysis of thermal ablation versus surgical nephrectomy for small renal tumours. Cardiovasc Intervent Radiol. 2014 Apr;37(2):427-37. {{doi|10.1007/s00270-014-0846-9}} 7. ^Kurup AN, Callstrom MR. Ablation of musculoskeletal metastases: pain palliation, fracture risk reduction, and oligometastatic disease. Tech Vasc Interv Radiol. 2013 Dec;16(4):253-61. {{doi|10.1053/j.tvir.2013.08.007}} 8. ^Barney Brooks, The Treatment of Traumatic Arteriovenous Fistula, Southern Medical Journal. 01/1930; 23(2):100-106. 9. ^Bown SG: Phototherapy in tumors. World J Surg 7:700–709, 1983 10. ^Deneve, Jeremiah L., Choi, Junsung, et al., Chemosaturation with Percutaneous Hepatic Perfusion for Unresectable Isolated Hepatic Metastases from Sarcoma, CardioVascular and Interventional Radiology, Volume 35, Issue 6, pp 1480-1487. {{doi|10.1007/s00270-012-0425-x}} 11. ^Cardiovascular and Interventional Radiological Society of Europe, "IR Procedures" 12. ^Napoli A, Anzidei M, Marincola BC, et al. MR imaging-guided focused ultrasound for treatment of bone metastasis. Radiographics. 2013 Oct;33(6):1555-68. {{doi|10.1148/rg.336125162}} 13. ^Gangi A, Basile A, Buy X, et al. Radiofrequency and laser ablation of spinal lesions. Semin Ultrasound CT MR. 2005 Apr;26(2):89-97 {{PMID|15856810}} 14. ^Salem R, Lewandowski RJ. Chemoembolization and radioembolization for hepatocellular carcinoma. Clin Gastroenterol Hepatol 2013 Jun;11(6):604-11; quiz e43-4. {{doi|10.1016/j.cgh.2012.12.039}} 15. ^Al-Adra DP, Gill RS, Axford SJ, et al. Treatment of unresectable intrahepatic cholangiocarcinoma with yttrium-90 radioembolization: a systematic review and pooled analysis. Eur J Surg Oncol. 2015 Jan;41(1):120-7. {{doi|10.1016/j.ejso.2014.09.007}} 16. ^Cancer Treatment Center of America, Intra-Arterial chemotherapy 17. ^Katsanos K, Ahmad F, Dourado R, Sabharwal T, Adam A. Interventional radiology in the elderly. Clin Interv Aging. 2009;4:1-15. Epub 2009 May 14. Review. {{PMC|2685220}} 18. ^European Conference of Interventional Oncology, "What is IO?" 19. ^Adam A, Kenny LM. Interventional oncology in multidisciplinary cancer treatment in the 21(st) century. Nat Rev Clin Oncol. 2015 Feb;12(2):105-13. {{doi|10.1038/nrclinonc.2014.211}} External links
3 : Oncology|Radiology|Cancer |
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