Ces radiol. 2010, 64(2):93-102

Interventional radiology in oncological diseasesOriginal article

Vlastimil Válek¹, Tomáš Andrašina¹, Zdeněk Kala², Igor Kiss², Jiří Tomášek^?, Lenka Ostřížková^?

¹ Radiologická klinika FN Brno, PMDV a LF MU v Brně

² Chirurgická klinika FN Brno, PMDV a LF MU v Brně

³ Klinika komplexní onkologické péče MOU a LF MU v Brně

⁴ Hematoonkologická klinika FN Brno, PMDV a LF MU v Brně

Aim: To provide an overview of radiological interventional methods for cancer patients including published and our own experience.

Method: We are systematically involved in performing oncological interventions since 1994. We first put into practice the implantation of metal self-expandible stents in patients with malignant stenosis of biliary tract, esophagus and colon, then we started to implement chemoembolization, regional chemotherapy, and finally, percutaneous ablation procedures. We have performed oncological interventions in more than 2,000 clients. Patients in our departement are indicated for these methods only on the basis of oncological indicating committee recommendations since 1997 and in the most of cases it is a comprehensive approach combining several of these procedures with chemotherapy or surgery.

Results: We retrospectively evaluated a set of 28 patients with HCC, in which we performed combination of RFA and TACE. We followed up them for recurrence in 1st, 2nd, 3rd and 5th year and we have reached survival of 68%, 45%, 38% and 21%. At 15% of patients, we continued to treat despite the progression of the disease and it should be emphasized that mainly extrahepatic disease progression may not be a reason for discontinuation of therapy. In our group of 72 patients with metastatic colorectal cancer with size of metastasis less than 5cm without extrahepatic disease, we reached median survival from the time of metastasis diagnosis 35.8 months with 95% confidence interval (30.9 to 42.8 months). 3 and 5 year survival rate was reached 49% and 22%. The average size of ablated lesions was 29 mm. In prospective randomized study of patients with cholangiocellular carcinoma we demonstrated that brachytherapy in combination with radiotherapy and the implantation of a metal stent increases survival from 233.5 days (in patients only with implantation of a stent) to 399.8 days in group with combination of methods. In our set of 20 patients with malignant billiary stenosis with a diagnosis of CCC, in which was performed implantation of a metal self expandible stent, brachytherapy and systemic chemotherapy, the median survival for these patients was 16.1 months. In the same study of 11 patients with combination of stent implantation, brachytherapy and chemoembolization median survival was 25.16 months.

Conclusion: Radiological interventions for oncological patients now offer wide range of palliative and curative procedures and should be offered in any complex oncology centers.

Keywords: HCC, metastasis, termoablation, chemoembolization, RFA, TACE, TACI, CCC, stent, brachytherapy

Accepted: April 15, 2010; Published: June 1, 2010  Show citation