Interventional radiologists use imaging tools to see inside the body and guide “incisionless” treatments. Our investigators are leaders in this evolving field, with new and less-invasive techniques under rapid development.
Image-guided therapies such as ablation, catheter hepatic arterial embolization, and selective internal radiation therapy are used to shrink or destroy liver tumors locally without surgery.
Ablation: Destruction of cancerous tissue
Ablation is a technique for destroying tumors without removing them surgically. Several forms of energy now can be used to selectively ablate tumors within the liver.
Ablation can be done with minimally invasive techniques on an outpatient basis (no hospital stay required). In many cases doctors can deliver the tumor-destroying energy through a needle-like probe inserted through the skin and guided into the tumor with the help of the latest imaging technologies.
The most commonly used ablation methods destroy the cancerous tissue through the application of heat delivered via radio waves (radiofrequency ablation) or microwaves (microwave ablation), or through cold gas to freeze the tumor (cryoablation). The selection of ablation type depends on the size, location, and shape of the tumor.
Increasingly, our surgeons and interventional radiologists perform ablation in combination with liver surgery to remove tumors that may be considered inoperable at other hospitals, such as metastases that occur in both sides of the liver.
Ablation also may be used to reduce the risk of cancer coming back in people with liver metastases that cannot be completely removed with surgery. The procedure may prolong survival for people with recurrent metastases who were previously treated with surgery and chemotherapy. It is also used in place of surgery for patients who are too sick to undergo an operation.
To clearly see the tumor during the ablation we use sophisticated image-guidance tools such as a CT scan or ultrasound. At Memorial Sloan Kettering we also use a dedicated PET/CT unit to target liver tumors that show up on the PET scan, increasing the accuracy and efficacy of ablation.
In addition, we are researching ways to sample tissue from the tumor to determine if it has biomarkers (early markers of disease) that might help in predicting the outcome of the ablation treatment.
Radioembolization/ Selective Internal Radiation Therapy (SIRT)
Another method used by our interventional radiologists is radioembolization. Also known as selective internal radiation therapy or SIRT, we mostly use this approach in people with liver metastases that cannot be removed surgically for various reasons, or for disease in which liver metastases are the primary problem. It is also used for people with tumors that are getting larger or not going away after chemotherapy.
Radioembolization combines radiation therapy with embolization, a procedure that involves injecting tiny particles to block or reduce blood flow to cancer cells, delivering and trapping tiny radioactive beads at the tumor site.
In this procedure, an interventional radiologist inserts a catheter into an artery in the groin and advances it into the hepatic artery, which supplies blood to the liver. The doctor then inserts tiny beads containing radioactive material directly into the artery supplying the liver tumor.
These beads deliver a very high dose of radiation therapy directly to the hepatic artery supplying the tumor while sparing normal liver tissue that is mostly supplied by the portal vein.
Radioembolization has been shown to shrink tumors — sometimes enough that they can be removed surgically or ablated. Investigations also show that the addition of this procedure to chemotherapy may control liver metastases for longer periods of time, and that it is safe to do even in people who had undergone several prior therapies (including systemic and arterial chemotherapy and surgery).