Pictured: Intraoperative Radiation Therapy (IORT) machine at Memorial Sloan Kettering Intraoperative Radiation Therapy machines enable us to safely administer high doses of radiation to precisely defined areas.

Techniques that enable surgeons to deliver therapies or confirm procedure status during the course of an operation can often enhance outcomes. At Memorial Sloan Kettering, we use multiple techniques for various types of cancer.

Hepatic Arterial Infusion

Video: Treating Liver Metastases with Hepatic Arterial Infusion Therapy
Nancy Kemeny, MD, discusses hepatic arterial infusion therapy for the treatment of liver metastases.

The administration of chemotherapy via the hepatic artery is a novel method of treating unresectable primary liver and bile duct cancers as well as liver metastases. Chemotherapy is delivered directly into the hepatic artery through a catheter. This approach spares the rest of the body from the side effects of the chemotherapy.

Memorial Sloan Kettering researchers are evaluating hepatic arterial infusion (HAI) for the treatment of gallbladder and bile duct cancers. HAI, which has been shown to extend survival in patients with liver cancer, involves delivering a high dose of chemotherapy drugs directly to the liver through a tiny pump implanted under the skin in the lower abdomen. Additional chemotherapy is injected into the pump, as needed, on an outpatient basis.

HAI therapy may be used to shrink tumors before surgery, or after surgery to prevent recurrence.

Intraoperative Radiation Therapy

Intraoperative radiation therapy (IORT) is delivered during the surgical removal of a tumor. While the patient is still in the operating room, a linear accelerator delivers a concentrated beam of electron radiation to the area where cancer cells could remain.

Because this treatment is conducted during surgery and can be targeted to a precisely defined area, higher-than-usual doses of radiation can be used, while sparing nearby healthy tissues.

Patients receiving IORT may have also received external-beam radiation therapy prior to the operation, or may receive additional external-beam radiation therapy postoperatively.

Intraoperative Imaging

To improve the success of surgery, our surgeons perform certain procedures, such as neurosurgery for cerebral, brain stem, and pituitary tumors, with an MRI scanner in the operating room. At any point during the operation, the surgeon can position the patient in the MRI machine to determine whether there is residual tumor. If any remaining tumor is detected, surgery can be resumed. Being able to reevaluate a patient's tumor with MRI during a procedure allows increased precision and reduces the risk associated with a second operation.

In addition, MRI may be useful to stage cancer in select patients in whom major blood vessels are compressed or invaded by tumor. MRI also discriminates the involvement of bone metastases and can help guide local treatment.

Our doctors have also developed a contrast-enhanced intraoperative CT scanning technique that generates clear and precise images. The approach reduces radiation requirements while improving diagnostic accuracy to a level approximating that of invasive procedures such as angiography. Contrast-enhanced fluoroscopy is also available intraoperatively. This type of real-time x-ray enables physicians to visualize internal structures and identify drainage areas.

Brachytherapy

During brachytherapy, tiny radioactive seeds are implanted in or near a tumor. Brachytherapy is a treatment option for some patients with head and neck, thoracic, gynecologic, gastrointestinal, breast, prostate, and ophthalmic cancers. Notably, Memorial Sloan Kettering's prostate implant program employs low-dose-rate brachytherapy with intraoperative conformal planning, in addition to high-dose-rate brachytherapy (HDR).

Our Brachytherapy Service has a dedicated operating room for radiation therapy, where intraoperative HDR treatment is used to manage locally advanced colorectal malignancies and other solid tumors.