Personalized Image-Guided Therapies for Local Malignencies: Interdisciplinary Options for Interventional Radiology and Interventional Radiotherapy

Abstract

Minimal-invasive interventions considerably extend the therapeutic spectrum in oncology and open new dimensions in terms of survival, tolerability and patient-friendliness. Through the influence of image-guided interventions, many interdisciplinary therapy concepts have significantly evolved, and this process is by far not yet over. The rapid progression of minimal-invasive technologies offers hope for new therapeutic concepts in the short, medium and long term. Image-guided hybrid-technologies complement and even replace in selected cases classic surgery. In this newly begun era of immune-oncology, interdisciplinary collaboration and the focus on individualized and patient-friendly therapies are crucial.

Percutaneous electrochemotherapy in primary and secondary liver malignancies – local tumor control and impact on overall survival

“…In these cases, ECT can truly be a valuable option, as it is a combined tumor therapy that enhances the local effect of a systemically administered chemotherapeutic drug by reversible electroporation. 26 The most commonly used chemotherapeutic agent is bleomycin, which, when combined with electroporation, has the major advantage of being cytotoxic regardless of the tumor's histology. The aim of minimally invasive, local ablative procedures is to destroy primary and secondary malignancies efficiently and gently at the same time using image guidance.…”

Long-Term Comparative Study on the Local Tumour Control of Different Ablation Technologies in Primary and Secondary Liver Malignancies

“…In microwave ablation (MWA), oscillating water molecules cause tissue heating. Compared to RFA, MWA systems operate in much higher frequency ranges (915 Hz–2.45 GHz) [ 2 , 5 ]. Because water, and not the tissue, is heated, MWA is also not limited by carbonisation.…”

“…However, it is undisputed that MWA is faster than RFA [ 7 ]. Indications for MWA in the liver are HCCs with a size of up to 5 cm or for metastases up to 4 cm [ 2 , 5 ]. However limited LTC after MWA is more likely to occur in lesions larger than 3 cm in diameter, lesions located near large vessels and the diaphragm, as well as in chemo-resistant metastases, e.g., of colorectal cancer [ 14 ].…”

“…In cryoablation (CRYO), alternating freezing (up to −150 °C) and thawing (up to 40 °C) leads to the desired tumour necrosis [ 2 , 5 ]. Cell death is induced by intracellular and extracellular processes.…”

“…Thus, perhaps the most outstanding advantage of LAT is that it significantly increases overall survival (OS) in combination with SCT compared to SCT alone [ 4 ]. Surgery was and still is the gold standard for removing malignancies, now flanked by newer and less invasive methods such as stereotactic ablative radiotherapy (SABR) and a multitude of LAT [ 5 ]. The core goals of LAT are the achievement of local tumour and symptom control in the gentlest possible way, and with the shortest possible hospitalization [ 6 ].The choice of LAT depends on the parameters “entity, number, size and location” of the targets and, last but not least, on the expertise and armamentarium available on site [ 2 ].…”