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Intraarterial procedures for the musculoskeletal system

Key points Intraarterial procedures are useful for pain palliation, local disease control and as an adjunct to a planned surgical intervention. Meticulous angiographic technique and careful monitoring of the patient’s neurologic status is essential for preventing complications during embolization of tumors in the spine. Specific strategies for embolization of tumors in the spine are discussed. Background The arterial system provides an extensive route of access to…

Vertebroplasty and kyphoplasty in malignant vertebral fracture

Key points Vertebroplasty and kyphoplasty are mainly used for pain relief. Tumor dissemination is an unknown factor in these techniques. Locoregional tumor control can be effective when combined with other techniques. Excessive vertebral destruction might need additional support by other material. Background Most oncologic patients (∼70%) eventually will develop a metastatic vertebral fracture/lesion because of their underlying disease. Although these fractures/lesions can be located at any…

Ablation of musculoskeletal metastatic lesions including cementoplasty

Key points Percutaneous ablation of bone and soft tissue metastases may be performed for palliation of pain, prevention of complications due to progressive disease, and local disease control in nonsurgical patients. Patients treated for palliation of painful metastases should have at least moderate pain levels, pain referable to a limited number of metastatic lesions on imaging, and target lesions separated (or separable) from critical normal structures.…

Musculoskeletal interventions for benign bone lesions

Key points Radiofrequency ablation is now the standard of care for the treatment of osteoid osteoma. Surgical treatments carry significant morbidity and recovery times. Improved image guidance techniques drive the increased use of ablation options in treatment of benign bone tumors. A familiarity with bone biopsy needles, mallets, and drills are needed when performing bone interventions. Neuroprotective measures including hydrodissection, CO 2 insulation, and nerve monitoring…

Percutaneous musculoskeletal biopsy

Key points Percutaneous musculoskeletal biopsy planning should involve multidisciplinary collaboration Recognize common “pseudotumors” and “don’t-touch lesions” A solitary bone lesion of unknown etiology is a primary tumor until proven otherwise Perform the biopsy with imaging modality that best demonstrates the lesion The biopsy needle path should: Be aligned with the proposed surgical incision Be confined to the anatomic compartment involved Not cross joint spaces, tendons, ligaments,…

Metastatic disease

Key points Interventional management of thoracic metastases involves careful consideration not only of parenchymal lesions, but also pleural and chest wall disease. Management of parenchymal metastases is similar to that of primary neoplasms, with the same technical considerations applying. Malignant effusion is the most common manifestation of pleural metastases that the interventionalist will be called upon to treat. This is largely accomplished through the use of…

Primary lung carcinoma

Key points Thermal ablation is a proven method for treatment of early-stage non–small cell lung carcinoma for patients who are medically inoperable. Basic approaches to lung biopsy and ablation are similar. The risks of lung intervention include pneumothorax, hemorrhage, and air embolism. Introduction Lung cancer is the leading cause of cancer-related death in the United States for both men and women. Using data acquired through the…

Head: Intracranial – gliomas, and meningiomas and extracranial – orbits, internal auditory canals, and skull base

Primary central nervous system tumors constitute a relatively rare, but significant, fatal health problem in the United States and the rest of the world. Every year in the United States approximately 44,000 new primary brain tumors are diagnosed, or 14 in every 100,000 citizens. Of these, approximately 60% are malignant and 45% are gliomas. Malignant gliomas are the second leading cause of cancer mortality in people…

Transcatheter chemotherapy for malignancies in the brain, head, and neck

Introduction Intraarterial chemotherapy has long been investigated as a potentially superior treatment modality for tumors of the cervicocephalic, thoracic and abdominopelvic regions, and the limbs. Tumors of the brain, head, and neck have attracted the most attention for several reasons. For brain tumors, particularly high-grade gliomas, the therapeutic benefits from systemic therapy are minimal, even for drugs with recognized activity and a demonstrated dose–response relationship. Theoretically,…

Imaging of head and neck cancer

Introduction Head and neck cancers are a complex, heterogeneous group of diseases with a variety of treatment options. Surgery, chemotherapy, and radiation all have a role. Outcomes data are often ambiguous, and the same tumor may be treated differently at different institutions, depending on the local expertise and experience. Cross-sectional imaging plays a central role in assessing the extent of disease, and in planning treatment strategies.…

Prostate cancer intervention

Key points Prostate interventions can be used to both diagnose and treat prostate cancer. Although none have been shown to affect outcomes, and the data regarding side effects is heterogeneous, most show low rates of incontinence and impotence. Patient and treatment modality selection is a complex consideration, with diagnostic imaging providing an important component. Some treatments are not widely available or approved for use in all…

Image-based interventional therapies for benign uterine neoplasms

Key points Uterine leiomyomata are common benign neoplasms that may cause symptoms related either to tissue bulk or bleeding for many women. Triage to the ideal treatment depends not only on fibroid characteristics and location within the uterus but also the patient’s fertility goals, nature of presenting symptoms, and consideration of potential complications. In addition to watchful waiting and traditional treatment, including medication for symptomatic relief,…

Interventional strategies in the treatment of gynecologic cancers

Key points Resection and chemotherapy are the mainstays of treatment for most advanced gynecologic cancers, but interventional strategies play an important role in the diagnosis and treatment of patients who are not surgical candidates. Image-guided biopsy is suggested in cases of suspected ovarian cancer with peritoneal carcinomatosis to help guide neoadjuvant chemotherapy and avoid unnecessary surgery in cases of nongynecologic primary cancers presenting with omental metastases.…

Percutaneous management of renal tumors

Key points Imaging plays an important role in diagnosis Thermal ablation is becoming a treatment option for select patients with small tumors techniques include radiofrequency and cryoablation long-term follow-up with imaging is necessary Embolization can be used in the treatment of angiomyolipomas, and in select patients with renal cell carcinoma Introduction Imaging has evolved to play a significant and integral role in both the diagnosis and…

Interventional oncology management of noncolorectal and nonneuroendocrine hepatic metastatic disease

Key points Liver metastasis is a major cause of mortality and morbidity in patients with cancers of various origins and presents a therapeutic challenge because only a few patients are candidates for surgical resection, and systemic chemotherapy offers limited benefit. Locoregional therapies have been shown to be safe and effective in selected patients with liver metastases from melanomas, breast cancer, and other gastrointestinal tumors. Introduction The…

Gastroenteropancreatic neuroendocrine tumors

Key points Incidence and prevalence of GEP-NET is increasing. Recently approved systemic targeted therapeutic agents and local therapies have rekindled interest in NET management. Multidisciplinary centers employing a myriad of tumor therapies including strategies of image-guided techniques are poised to play a significant role in the management of these complex patients. Introduction The neuroendocrine system exists in two phenotypes, either as (1) discreet organoid aggregates (pituitary,…

Interventional radiology in the management of colorectal cancer liver metastases

Colon cancer—an overview Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer, the second leading cause of cancer-related death in the United States, and recent studies estimate that 100,000 new cases of colon cancer and 40,000 of rectal cancer will occur annually. During the same time, 50,000 people will die from CRC. Within the past 30 years, the incidence of CRC has decreased from 60.5…

Surgical management of hepatic metastases

Key points Precise assessment of disease progression and adequate selection of initial therapeutic options should be performed through a multidisciplinary approach in the treatment of liver metastases. Selected patients with colorectal liver metastases are candidates for curative hepatic resection with 5-year survival up to 58%. Number, size, and bilobar distribution of liver metastases do not limit the indication of surgery when R0 resection is feasible. Surgical…

The multidisciplinary management of liver metastases in colorectal cancer

Key points The treatment of colorectal cancer, metastatic to liver, should be optimally managed within the context of a multidisciplinary team to improve patient-centered outcomes. Treatment intent should be categorized as ““curative,” “potentially curative,” “noncurative for active therapy” (the majority) and “noncurative for palliation” of symptoms (best supportive care). Increasing options for combined modality approaches require a treatment pathway and strategy, both at the outset (first…