Interventional oncology has been called the fourth pillar of oncology—teaming up with medical oncology, surgical oncology, and radiation oncology disciplines in the fight against cancer. Recent data, reported in this supplement, suggest that interventional oncologic treatments for hepatocellular carcinoma can shrink tumors, relieve painful symptoms, improve quality of life, and potentially extend survival in patients who cannot be treated effectively with other approaches.
Daniel B. Brown, MD, FSIR, Chief of Interventional Oncology, at Vanderbilt University Medical Center, was this year's Chair for the Society of Interventional Radiology (SIR) 2014 Annual Scientific Meeting in San Diego.
There are essentially two roles that interventional oncologists are playing in the treatment of patients with hepatocellular carcinoma. I look at patients in one of two groups: those who are trying to go to transplant and those at their destination therapy, meaning this [interventional therapy] is going to be their primary modality of care. An additional group is composed of patients we cannot treat whom we direct toward hospice or palliative care.
For the patients seeking transplant, the interventional oncologist aims to slow tumor progression. Patients are able to receive a transplant if the size of the tumor is within certain criteria, either the Milan or University of California, San Francisco (UCSF) criteria (see sidebar on page 6). We either try to keep the tumor within those criteria or reduce the size of the tumor to fit the criteria that would qualify the patient for a transplant. We do this because for a patient with nonresectable disease, transplant is that patient’s only chance of being alive in 5 years.
For patients who are ineligible for transplant—ie, the tumors are too big, or the patient is too old or has too much medical comorbidity—arterial or ablative therapies are standard of care. If patients are not eligible to get a liver transplant, the tumors probably cannot be resected. In such cases, survival up to 4 years is being reported using chemoembolization with drug-eluting beads.
