Interventional oncology: the future

Abstract

Interventional radiology techniques to treat oncological disease have already shown value in adults. The adoption and development of interventional oncology (IO) in children have been more limited and challenging. This relates to the approval process for new devices and agents, oncology group protocol limitations and the inherent hesitation of trying new treatments in children. This paper will discuss how new procedures are developed and approved, and the new therapies that will become available to better treat pediatric malignancies. Bringing the benefits of IO to children will require initiative on the part of pediatric diagnostic and interventional radiologists as well as the cooperation of our clinical colleagues.Keywords Interventional oncology . Cancer . Children The challengeUnfortunately, many pediatric interventional radiologists are frequently limited in introducing novel oncological interventions by their institutions' pediatric oncologists and surgeons. The future of pediatric interventional oncology (IO) depends on the initiative of pediatric radiologists, pediatric interventional radiologists, pediatric surgeons and pediatric radiation oncologists. We must either lead the adult experience as our pediatric oncologists now do, or follow the adult experience as commonly occurs in radiology. The processNearly all therapeutic pediatric oncology is performed under prospective clinical trials and protocols associated with large cooperative oncology groups (often funded by individuals, special interest associations and government grants) after scrutiny by scientific committees and institutional review board (IRB) approval.

Ethical issues of clinical trials in paediatric oncology from 2003 to 2013: a systematic review

“…52 Ethical assessment is made following general (assent and consent, benevolence, non-malevolence, justice and dignity) 22,43,50,54 or ad-hoc principles (feasibility, risk-minimisation, benefit maximisation, a risk-benefit profile comparable to alternatives, research interventions commensurate with patient's experience). 23,46,74 Despite efforts to follow these principles, two main limitations impinge the soundness and relevance of ethical assessments, namely their perceived exteriority ("I would really want to know who those people are"), 57 and their intrinsic variability, for they include comparisons ("alternatives") and valuations ("prospect of important direct benefit"). 8,23,46,54,69 Empirical data shall contribute to improve the consistency of ethical evaluations.…”

“…26,28,46,51,69,70,76 Other barriers relate to specifics of paediatric oncology (access to new compounds, small populations). 10,11,22,24,74,78 A policy shift is identified from conditionally allowing (as an exception), to positively encouraging, paediatric research. 28,68 This shift implies to reconcile the two legal logics of protection (safeguards, hard law) and of innovation (incentives, soft law).…”

Utility and efficacy of navigation system use in interventional radiology

“…As technology changes, it is imperative to appreciate the new direction of treatment so patients have access to well trained expert interventional radiologists and imaging experts working in proper environments with the right equipment [11]. Previous investigations have demonstrated that interventional radiology has value in adults [12]. This investigation provides evidence of the integration of navigation systems in the discipline and the benefits and potential drawbacks.…”

Unresectable hepatoblastoma: current perspectives

“…This evolution has been limited by the slow development and approval of new devices for use in children, patient size limitations, and the hesitation to test novel treatment approaches in pediatric patients. 28 There are numerous interventional radiology modalities available for the treatment of oncology patients, particularly those with liver tumors, with a range of experiences already published in the adult literature. 29 – 32 More recently, these interventional approaches have been introduced to the pediatric population as detailed in the following.…”