Advances in Interventional Oncology Enable More Focused Treatments in Liver Cancer Care

Cancer continues to be a leading cause of death worldwide. An estimated 19.3 million new cancer cases and almost 10.0 million cancer deaths occurred in 2020[1]. The American Cancer Society projects 1.9 million new cancers will be diagnosed in the US in 2021.

Remarkable advances in cancer treatment are breaking previous limitations and offering clinicians new and more capable tools to combat these cancer cases. Clinicians, with the help of targeted cancer therapies, are able to deliver personalized healthcare with the right treatment at the right time to maximize treatment efficacy and achieve better health outcomes for patients. The traditional pillars of cancer treatment: surgery, radiotherapy, and chemotherapy now have the benefit of an additional pillar to diversify the options for cancer treatment, interventional oncology.

Significant advances in medical imaging technology have allowed interventional oncologists to bring image-guided procedures into daily clinical practice and make targeted cancer treatment possible.  Specifically in organ cancers, and cancers where systemic treatments are less effective, interventional oncology is advancing more focused treatments using locoregional delivery directly to the tumor, sparing as much healthy tissue as possible. As interventional oncology’s targeted treatments become standard of care worldwide, especially in areas such as liver cancer, they can have a real impact on the overall patient experience including improved results and prolonged survival.  

Increasing use of interventional oncology procedures to diagnose and deliver cancer treatments

Image‐guided oncology interventions have helped clinicians make tremendous progress in treating cancer over the last decade. Interventional oncology works by using image-guided approaches to treat any malignancy that can be reached by needle or catheter. High-quality medical imaging can visualize the navigation path and destination for delivery of patients’ targeted treatment which can be completed less invasively. Needle biopsies and other types of interventional treatments are generally preferable when compared to more invasive alternatives to treat cancer, given the risks of infection and damage to surrounding healthy tissues.

The annual utilization of interventional oncology procedures in the U.S. alone is estimated in the millions[2]. Most patients with cancer will undergo at least one image‐guided biopsy prior to treatment, and many more patients will undergo palliative and symptomatic image‐guided treatments. Interventional oncology leverages the power of imaging, particularly cross-sectional imaging including live X-ray, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). Medical imaging is critical for pre-procedure planning, intraprocedural targeting, intraprocedural monitoring, intraprocedural control, and post-procedure assessment. Supported by advanced imaging technologies, interventional oncology is considered the fourth pillar of modern oncology care[3].

Growing role of Interventional Oncology in Liver Cancer Treatments

Liver cancer is the fifth most common cancer, accounting for 8.2 percent of all cancer deaths worldwide[4]. The incidence is rising across all continents. A study published in JAMA Oncology, December 2017 found the incidence of liver cancer increased by 75 percent worldwide between 1990 and 2015[5].

Effective surveillance programs with imaging could offer early diagnosis and provide an opportunity for better treatment options. Cancer patients today can benefit from increasingly differentiated cancer treatment strategies including interventional oncology. Interventional oncology procedures treat tumors in the bones, lungs, liver, kidneys adrenal glands and other soft tissues in the body. Typically reserved for patients whose tumors are unresectable, interventional oncology treatments include techniques such as embolization, which inhibits blood supply to a tumor, cryoablation, which is a technique to kill tumor cells using extreme cold, and microwave ablation, which destroys tumor cells using heat generated by microwave energy. 

As these precision oncology approaches mature, using frequent tissue harvests to understand cancer's precise genetic and immune composition is critical. New imaging tools such as GE Healthcare’s Liver Assist* offers clinicians real-time simulation of injection points that help to define optimal navigation through hyper vascularized anatomy of the liver to reach the lesion. The use of catheter‐directed therapies as well as image‐guided ablative treatments have also been shown to prolong survival in patients with hepatocellular carcinoma (HCC), the most common malignant tumor of the liver[6].

Hepatocellular cancer, as well as other neuro endocrine tumors and carcinoids has historically been unresponsive to traditional radiation and chemotherapy regimens, but patients have shown improvement with the use of minimally invasive interventional oncology procedures such as transcatheter arterial chemoembolization (TACE), which sends and traps chemotherapy agents in the tumor and then cuts off its vascular blood supply, causing cell death in the tumor and suppressing further tumor growth.

While TACE is not a new treatment, coupling TACE with traditional systemic treatments has a role in delaying the progression of HCC and has been indicated in select patients with early-stage HCC. Until recently, TACE has most commonly been used as a palliative treatment for HCC patients[7].

Working on multi-disciplinary teams, interventional oncologists have found success in using new advances in interventional therapies in combination with traditional resection and systemic treatments of radiation and chemotherapy.  Research is ongoing and continues to demonstrate the effectiveness of interventional oncology treatments, as well as the development of new chemotherapy agents and pharmaceuticals to target organ and neuro endocrine cancers, will continue to increase the demand for these minimally invasive procedures, which are resulting in the innovative design of more flexible OR/treatment rooms, powered by high-quality medical imaging tools.

Designing treatment areas with flexible yet powerful imaging options

Today’s imaging capabilities have enabled clinicians to visualize tumor vasculature with a level of detail that has not before been possible, optimizing their application in interventional procedures. Imaging equipment manufacturers have coupled innovative system design based on end user needs in interventional procedures with the technology advances that enable live imaging techniques to perform minimally invasive biopsy and treatment procedures. These engineering innovations in device design for oncology have led to new image-guided techniques such as biopsy tissue acquisition, tumor ablation, and transcatheter delivery of chemotherapy agents to tumors.

“We’re designing systems with maximized flexibility for the user in the oncology space,” says Gustavo Perez, President and CEO of GE Healthcare Image-Guided Solutions, “making high-quality imaging systems easy to access, maneuver, position and operate with the space needed to work efficiently. Multi-disciplinary cancer care teams need to clearly visualize patients’ vessels, organs and soft tissues to perform many different and highly effective image-guided procedures such as tumor embolization and ablation techniques.”

Furthermore, the utilization of hybrid operating rooms (ORs) is increasing, keeping pace with the number of minimally invasive cancer procedures that have been developed and approved. Rather than have radiology as a separate room or department, it is being integrated inside these hybrid rooms. Hybrid ORs come with advanced equipment that enables surgeons, radiologists, and other medical providers to use real-time images for guidance during complex procedures such as needle biopsies. Traditional ORs typically use mobile imaging equipment, but these systems aren’t capable of producing the fine detail that high-quality images provide for delicate interventional procedures. Hybrid ORs now include built-in C-arms for fluoroscopic intraoperative imaging, as well as ultrasound, X-ray, CT, and MRI equipment.

The future is bright for interventional oncology and precision cancer care

As clinicians develop integrated cancer care paths for patients that incorporate a multidisciplinary approach, interventional image-guided systems can offer an improved patient experience for what can be a complex journey. Patients can benefit from interventional technology’s super-selective tumor targeting and reduced damage to their healthy tissues. Technological developments, advances in imaging, new contrast agents and complex navigation algorithms have given clinicians the precision to plan therapies on the tumor, driving the increasing utilization of interventional oncology in support of cancer care. This shift toward precision cancer care along with the growing demand for faster, increasingly individualized and more affordable solutions has necessitated the adoption of interventional oncology as the fourth pillar of cancer care, and as such, holds high growth potential and a promising future[8].

 

To learn more about GE Healthcare’s oncology solutions, click here.

To read more about GE Healthcare interventional image-guided systems, click here.