Minimally Invasive Cancer Treatments
Thermal Ablative Therapies
• Radio-frequency ablation (RFA) or microwave ablation (MWA) are procedures used to treat a variety of inoperable tumors in a minimally invasive fashion. RFA/MWA use energy delivered through a metal probe inserted into a tumor under radiographic guidance. Delivered energy causes atoms in the cells to vibrate and create friction. This generates heat leading to death of tumor cells. The heat generated in tissues treated with RFA/MWA energy causes permanent damage and destruction of tumor cells.
• RFA/MWA is safe, effective treatment option approved by the FDA for liver, lung, bone and soft tissue. Ablation studies have shown significant benefit for patients with tumors in various locations including liver (primary and secondary) breast (combined with surgery to treat early stage cancers), kidney, lung (predominantly stage I and stage II disease), bone, adrenal and soft tissue. Most importantly, RFA/MWA can be an effective treatment for patients whose cancers cannot be treated surgically. Ablation for small tumors is considered as effective as resection.
Chemo-Embolization Therapies
• Chemoembolization is a regional treatment of the liver for various types of liver cancers. In this treatment, special drug eluting beads loaded with highly concentrated chemotherapy (often doxorubicin, irinotecan or gemzar) are injected into the hepatic artery feeding the tumor. The chemotherapy elutes out over time providing dramatically superior pharmacokinetics and far less systemic toxicity. Traditionally, metastatic colorectal carcinoma, neuroendocrine tumors, sarcomas, breast cancer, ocular melanoma and primary hepatoma and cholangiocarcinoma are the commonest tumor types treated. Two randomized controlled studies showed in 2003 that chemoembolization does prolong survival in patients with HCC.
Cryotherapy
• Cryotherapy technology uses temperatures of negative 40 degrees Celsius during freeze and thaw cycles to create an ice ball that eventually bursts the tumor. Using ultrasound as a guide, surgeons insert the needles directly into the tumor using minimally invasive techniques that require no or minimal incisions. The needles deliver the cold gases that destroy the cancer cells.
• Kidney Cryotherapy is most effective to treat early stage cancer with small tumors of 4 cm or less and for people who cannot have surgery for other health reasons. The procedure destroys the tumor, but keeps the kidney intact. Surgeons use a minimally invasive, laparoscopic approach with minuscule incisions to reach the kidney. Cold gases are delivered through the needles to destroy the cancer cells.
SIR-Spheres/Thera-Sphere Therapy/Radioembolization/Selective Internal Radiation Therapy (SIRT)
• SIR-Sphere and Thera-sphere treatment is a regional treatment to the liver. Unlike chemoembolization, which can cause a significant post-embolization syndrome of pain and nausea and requires at least one night stay in the hospital, SIRT is performed as an outpatient and has almost no side effects. No tumor is resistant to the very high doses of radiation delivered in this fashion. Early studies have shown outcomes rivaling or surpasing chemoembolization. Quality of life can improve and life expectancy may increase. For some patients, treatment with SIR-spheres can cause marked shrinkage of the liver tumor allowing for surgical removal at a later date. This has resulted in a long-term cure for some patients. Radioembolization can be performed concomitantly with systemic therapies. SIRT has begun to replace chemoembolization as the preferred manner to treat primary and secondary tumors of the liver.