About What is IO?

What is Interventional Oncology?

Interventional oncology (IO) therapies use image-guided, minimally invasive procedures to target cancer and cancer-related diseases deep inside the body. Therapies are delivered through incisions in the skin as small as pinholes, reducing time, pain, and risk to cancer patients. As the fastest growing pillar of modern oncology care, IO is driven by technological innovation and focused on three main areas of cancer intervention: diagnosis, therapy, and symptom management.

Cancer Diagnosis

IO practitioners use image guidance to obtain tissue for cancer diagnosis and individualized care.

Cancer Treatment

IO can treat cancers in several ways. First, IO precisely delivers therapeutic agents into tumors using intravascular catheters and direct intratumoral injection. Second, it targets tumors using image guided delivery of devices and agents to destroy tumor cells or for combination therapy. Third, for certain early-stage cancers, the use of minimally-invasive ablative techniques using specialized probes can completely eradicate the tumor.

Cancer Symptoms and Pain Management

IO symptom relief techniques include techniques that reduce pain in patients suffering from cancer, improving their quality of life and ability to manage additional cancer treatments.

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History of IO

While interventional oncology (IO) is a relatively young field, its history spans many decades. Born out of the specialty of interventional radiology (IR), IO encompasses the rapid growth in the use of minimally invasive techniques to treat cancer and manage its symptoms. As IR arose in the mid-20^th century, interventional radiologists began exploring these minimally-invasive applications in cancer. Early studies were published in the 1950’s and 1960’s, assessing blood supply to tumors (1) and preliminary data on the value of angiographic techniques to deliver these precise treatments to cancer cells (2).

In the 1970’s, catheter embolization, an interventional technique used to stop blood flow to tumors, demonstrated the ability of these procedures to treat solid tumors in the liver, kidney, skeleton, and other organs (3,4) in patients who may not have been optimal candidates for surgical procedures. In the 1980’s, chemoembolization and other therapeutic agents were adopted for treatment for hepatocellular carcinoma (HCC). Thermal ablative technologies such as radiofrequency ablation, microwave ablation, and cryoablation are now standard practice treating tumors in the lung, liver, kidney, and musculoskeletal system. Non-thermal technologies using electrical pulses including irreversible electroporation and pulsed electrical fields can be applied in thermally sensitive areas, while magnetic resonance (MR)- or ultrasound (US)-guided high intensity focused ultrasound (HIFU) and histotripsy are completely non-invasive approaches.

Over the last four decades, the combination of research and increasingly sophisticated technology have made it possible for multiple IO therapies to emerge and demonstrate effectiveness in treating many cancer types. Together with other specialists in oncology – medical, surgical, and radiation – interventional oncologists play a critical role on the cancer care team, treating patients in clinics, hospitals, and serving on tumor boards and multidisciplinary treatment teams (5).

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IO Therapies

Radioembolization

This is a minimally invasive treatment that delivers radiation directly to the liver to treat liver tumors. These procedures target cancer tumors in the liver while limiting side effects to the healthy parts of the organ.

Chemoembolization

This treatment directly delivers chemotherapy into the blood vessels that feed cancerous tumors without exposing the rest of the body to the chemotherapy drug. These procedures use image guidance to direct catheters and intratumoral injections.

Ablation procedures (Cryoablation, Microwave Ablation, Radiofrequency Ablation)

These treatments use the direct application of heat (microwave and radiofrequency) or cold (cryoablation) to eradicate tumor cells while preserving the healthy portions of the affected organ. These procedures have been shown to be just as effective as surgery in some tumor types.

References:

Bierman HR, Kelly KH, Byron Jr RL, Dod KS, Shimkin MB. Studies on the blood supply of tumors in man. II. Intra-arterial nitrogen mustard therapy of cutaneous lesions. J Natl Cancer Inst 1951 apr;11(5):891-905.
Deitrich FS, Cope C, Rivers S, Krantz S, Baum G, Beck HJ, Rodensky PL. Clinical trial with alanine mustard. Cancer Chemother Rep. 1962 Oct;23:31-8.
D E Wagner, S Baum. Preliminary arteriography in hepatic artery infusions for cancer. Surg Gynecol Obstet 1965;120:817-9.
Baum S, Kuroda K, Roy RH. The value of special angiographic techniques in the management of patients with abdominal neoplasms. Rad Clin N Amer 1965 Dec;3(3):583-99
Goldstein HM, Medellin H, Beydoun MT, Wallace S, Ben-Menachem Y, Bracken RB, Johnson DE. Transcatheter embolization of renal cell carcinoma. Am J Roentgenol Radium Ther Nucl Med. 1975 Mar;123(3):557-62
Livraghi T, Festi D, Monti F, Salmi A, Vettori C . US-guided percutaneous alcohol injection of small hepatic and abdominal tumors. Radiology. 1986 Nov;161(2):309-12
Livraghi T, Giorgio A, Marin G, Salmi A, de Sio I, Bolondi L, Pompili M, Brunello F, Lazzaroni S, Torzilli G, et al. Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology. 1995 Oct;197(1):101-8.