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Interventional Radiology in Cancer Patients

Interventional Radiology in Cancer Patients. C. Douglas Edmondson, M.D., FACR Interventional and Diagnostic Radiologist. What does IR do?. Diagnosis Primary treatment of cancer Treatment of cancer related complications or sequelae. Diagnosis. Image guided biopsy

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Interventional Radiology in Cancer Patients

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  1. Interventional Radiology in Cancer Patients • C. Douglas Edmondson, M.D., FACR Interventional and Diagnostic Radiologist

  2. What does IR do? • Diagnosis • Primary treatment of cancer • Treatment of cancer related complications or sequelae

  3. Diagnosis • Image guided biopsy • Aspiration or Drainage of fluid collections

  4. Examples of Bx needle

  5. CT of needle in tumor

  6. Fluoroscopic image of needle in lung tumor

  7. Ultrasound image of needle in tumor

  8. Malignant pleural fluid

  9. Safe – T – Centesis Catheter

  10. CXR before and after tap

  11. Primary treatment of cancer • Transcatheter chemoembolization • Transcatheter gene therapy • Central venous access • Tumor ablation • Sclerotherapy • Radiofrequency ablation (RFA) • Microwave • Freeze

  12. ChemoEmbo • Typically in the hepatic artery for Hepatocellular Ca or susceptible metastasis. • Attacks the tumor with concentrated dose of chemotherapy or radioactive beads and embolic materials to stop blood flow to starve and poison the tumor or fry it with Beta irradiation OR all of these agents.

  13. Before and after angiograms

  14. CT scan of embolic material in liver

  15. Radiofrequency Ablation • 15 -18g needle or needles placed into the tumor usually by CT guidance for best control. • Radiofrequency applied across the field and the tumor is coagulated and “cooked” at about 110 degrees. • Very promising results in many applications. Ever expanding indications.

  16. RFA needle

  17. CT of RFA in Place

  18. Before and After CT Scans of renal cell carcinoma

  19. Treatment of Cancer related complications or sequelae • Pain Control • Vertebral interventions • Drainage

  20. Pain Control • Pain usually arises from invasion especially nerve involvement. • Pancreatic cancer does not respond to any conventional therapy when usually discovered. Treat the terrible pain with celiac axis ablation. • Other areas such as stelate ganglion in neck, spinal nerves as they leave the spinal foramina respond to image guided ablations.

  21. Pancreatic Ca with Celiac axis ablation

  22. Vertebroplasty/Kyphoplasty • 11 – 14 g needles placed into vertebral body and PMMA cement injected. • Eliminates pain in over 80% of metastatic lesions • Kills tumor with heat as cement hardens • Stabilizes bone?

  23. Model of needle in vertebral body

  24. Needles and PMMA in the vertebra during Vertebroplasty

  25. Needle and balloon in vertebra during Kyphoplasty

  26. CT of PMMA in the bone

  27. Drainage and bypass • Biliary obstruction • Ureteral obstruction • Abcess and necrotic tumor mass effect • Palliative thorocentesis or paracentesis (serial taps or permanent catheter).

  28. Biliary Drain and Stent

  29. Pleur-X drain

  30. Summary • IR can aid with diagnosis, primary treatment, management of complications and palliation of sequelae • IR can do many of these with equal or better success than conventional treatments • IR can do many procedures cheaper and with less complications than more traditional approaches • Nearly all procedures are OP and with local anesthetic and IVCS. • Future procedures are on the bright horizon of IR

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