Interventional Radiology

The interventional radiology (IR) team at New York Cancer & Blood Specialists perform minimally invasive therapies using imaging to guide minimally invasive procedures that diagnose, treat, and cure many conditions. Interventional radiology procedures are often less expensive, less risky, and less painful than traditional surgery.  Many patients can potentially benefit from these procedures but are unaware of the option. 

IR is one of the pillars of treatment for both primary and secondary tumors. A patient’s first encounter with IR might be an image-guided biopsy, which uses ultrasound or CT to guide a needle directly into the tumor. Previously, biopsies required being cut open or laparoscopic surgery to take a piece of the liver. With IR, the whole biopsy procedure takes about ten minutes. The procedures can be performed with either sedation or local anesthesia. Patients leave the same day with a band-aid and no incisions.

The two main types of IR procedures that treat cancers are ablation and embolization. Ablation is a needle-based procedure that uses heat or cold to destroy the tumors. At NYCBS, microwave ablation is performed using the latest and most advanced system, NEUWAVE Microwave Ablation System. The system allows for more precise and complete treatment of tumors. Similar to a biopsy, imaging is used to guide a needle into the tumor, but instead, this needle emits microwaves that heat the tumor, burn, and destroy it. Ablation procedures can, in certain instances, completely cure cancer, for example, stage 1 renal cell carcinoma and BCLC stage 0 and stage A Hepatocellular Carcinoma (HCC). Ablation is a good treatment option for patients who are not good surgical candidates or have such small tumors that they do not necessarily need more extensive surgery. Patients recover just as quickly from the ablation procedure as from biopsies. They are monitored for two hours and then go home.

For patients with painful metastatic bone lesions, ablation is helpful not only for curing tumors but also as a palliative procedure. Although burning the painful bone tumors may not cure the cancer, it can help provide lasting pain relief. This can also be combined with external beam radiation for additional pain control.

Embolization is another outpatient IR cancer treatment. Embolization blocks arterial blood flow to tumors using tiny particles injected through a catheter directly into the organ with the tumors. For example, primary liver cancer (HCC) is a very arterial vascular type of tumor that responds well to embolization. When treating one or few focal tumors, the interventional radiologist can get into the specific tiny vessel that feeds only that tumor (or at least primarily that tumor and just a small part of the surrounding liver). The normal liver gets its blood supply mainly from the portal vein. So even if the entire hepatic artery is blocked, the normal liver tissue still survives while the tumors die. For patients with certain types of diffuse metastatic liver disease, embolization of an entire lobe or even the entire liver can be performed. When embolizing the entire liver, treatment is usually performed over two separate sessions.  This usually helps to shrink the tumors throughout the whole liver but leaves the normal liver tissue mostly intact.

Unlike surgery, with embolization, patients have no or minimal scarring. Embolization often works part of the way and shrinks the tumors but does not always eliminate them. In those cases, we can repeat the procedures as often as needed to keep the tumors under control. For example, with primary cancer of the liver, Hepatocellular carcinoma (HCC), if it doesn't work the first time, we can repeat the procedure the following month. The goal is to cure the cancer in that case by repeating the process and being more aggressive until the tumor is destroyed. For patients with diffuse metastatic disease, the goal is tumor control rather than cure.  These patients may experience regression or shrinking of the tumors, and then a year after treatment, the tumors may recur or progress.  If the tumors recur or progress, embolization can be repeated as often as needed. 

Chemoembolization is a specific type of arterial embolization in which particles are mixed with chemotherapy that is also injected into the tumors. That allows the tumor to be hit with 50 times as much chemo as during a regular chemo infusion, but the patient's body will still get less than a regular chemo infusion. As a result, patients don't experience the chemo side effects even though they are getting very high doses of chemo directly into the tumor. 

Embolization and ablation can also work together. For example, if there is a large tumor, it might need to be embolized first to block its blood supply and shrink it so that it can then be more easily burned with ablation. By decreasing the blood flow first, embolization stops the blood from carrying heat away from the tumor and allows the ablation to reach higher temperatures to better kill larger tumors.

Prostate cancer can also be treated using embolization. By shrinking the prostate and moving it away from the rectum and other delicate structures, the embolization allows external beam radiation to cure the prostate cancer without damaging the rectum or other structures nearby. In addition, by shrinking the prostate's total volume, the total radiation dose needed for treatment can also be reduced.

Embolization can be used to treat not only cancer but also benign lesions in different organs.  In the kidney, embolization can be used to treat benign tumors called angiomyolipomas that can otherwise cause internal bleeding. Prostate artery embolization has become a popular treatment to shrink the prostate in patients with trouble urinating due to benign prostatic hyperplasia (BPH). Uterine Fibroid Embolization is another treatment that can help patients with heavy menstrual bleeding or pain related to fibroids, adenomyosis, or endometriosis. 

Embolization and ablation are amazing procedures with various uses that can really help our patients.  Advancements in embolization and ablation are occurring all the time, leading to new and improved types of treatments.