Stephen Solomon, Chief of the Interventional Radiology Service, discusses techniques used at our state-of-the-art Center for Image Guided Intervention—from minimally invasive biopsies to palliative procedures.
The interventional radiologists at Memorial Sloan Kettering use sophisticated imaging tools to see what is going on inside the body and treat liver metastases without surgery. The image-guided therapies they use can shrink or destroy tumors:
Ablation to Destroy Liver Metastases
Ablation is a technique for eliminating tumors without surgery. Our radiologists use several forms of energy to select which tumors to ablate. This procedure can be done with minimally invasive techniques on an outpatient basis (no hospital stay needed).
Often, our doctors can deliver tumor-eliminating energy through a needlelike probe that they insert through the skin and guide into the tumor with the help of advanced imaging technologies.
The most common ablation methods destroy the cancerous tissue through the application of heat delivered by radio waves (radiofrequency ablation) or microwaves (microwave ablation), or through cold gas to freeze the tumor (cryoablation).
Our liver metastases experts choose the appropriate ablation therapy based on the size, location, and shape of the tumor.
More and more, our surgeons and interventional radiologists perform ablation in combination with liver surgery to remove tumors that other hospitals may consider inoperable. An example of this are metastases that develop in both sides of the liver.
Ablation may also reduce the risk of cancer coming back for people with liver metastases that can’t be completely removed. It may prolong survival for people with recurrent metastases whom doctors previously treated with surgery and chemotherapy.
It’s also used in place of surgery for patients who are too sick to undergo an operation.
Sophisticated image-guidance tools, such as a CT scan or ultrasound, allow our doctors to clearly see the tumor during ablation. At MSK, we also use a dedicated PET/CT unit to target liver tumors that show up on the PET scan, increasing the ablation’s accuracy and effectiveness.
Researchers at MSK are looking into ways to sample tissue from a tumor to determine if it has biomarkers (early markers of disease) that might help our liver metastases experts predict ablation outcomes.
Radioembolization/Selective Internal Radiation Therapy (SIRT)
Our interventional radiologists use radioembolization, also known as selective internal radiation therapy (SIRT), for people who have liver metastases that a surgeon can’t remove, or whose liver metastases are the primary problem. Our doctors also use SIRT for people with tumors that are getting larger or aren’t responding to chemotherapy.
SIRT combines radiation therapy with embolization, which involves injecting tiny particles to block or reduce blood flow to cancer cells. In SIRT, tiny radioactive beads are delivered to the tumor site and trapped there.
In this procedure:
an interventional radiologist inserts a catheter into an artery in the groin and moves it into the hepatic artery, which supplies blood to the liver
the doctor inserts tiny radioactive beads directly into the hepatic artery. These beads deliver a very high dose of radiation directly to the tumor’s blood supply. But they don’t affect normal liver tissue that gets blood from a different source.
Radioembolization can sometimes shrink tumors so much that a surgeon or doctor can remove, or ablate, them.
Research shows that combining a SIRT procedure with chemotherapy may control liver metastases for longer periods of time. It also appears to be safe for people who’ve already had several treatments for liver metastases.