By Helen K. Kelley
Interventional radiologists continue to expand the number of diseases and conditions that can be treated with minimally invasive techniques. Atlanta Medicine recently spoke with two Atlanta-area physicians who are performing some innovative procedures for patients with certain types of cancer, spine fractures, neuropathies and more.
Image guidance improves efficacy of cancer treatments
Praveen Reddy, M.D., a vascular and interventional radiologist with Northside Radiology Associates, says that advances in interventional radiology (IR) are making a big difference in the oncology field.
“Today, we have a wide spectrum of interventional treatments that can help cancer patients, from basic procedures like installing chest ports that are used to deliver chemotherapy to chemoembolization, in which anti-cancer drugs are injected directly into the blood vessel feeding a cancerous tumor. For example, to treat liver cancer, we can insert a catheter into the hepatic artery for direct delivery of chemotherapy,” he says. “In addition to chemotherapy, we have techniques for the direct delivery of radiation and local treatments with ablative therapy with radiofrequency ablation, cryoablation and microwave ablation.”
Reddy adds that people with osteoporosis often experience fractures of the spine that can be treated successfully through an interventional radiological technique.
“For this condition, we insert needles into the spine to inject a compound that stabilizes the fractures. Most patients experience relief from their pain within hours,” he says. “This procedure is especially beneficial for older adults who are at higher risk for developing pneumonia and other illnesses if they cannot be active.”
Additionally, IR is a mainstay in women’s interventions, including uterine artery and emergent embolization, according to Reddy.
“One of the most common procedures we perform is uterine artery embolization for symptomatic fibroid tumors. It’s a nonsurgical treatment that stops the blood flow to the fibroids and gives relief from symptoms such as bleeding and pain,” he says. “We can also perform emergent embolization with Caesarian sections and baby deliveries that have gone awry to stop significant bleeding.”
Reddy states that data being gathered from clinical trials has proven efficacy of these and other IR procedures.
“We’re currently looking at the data for the interventional delivery of chemotherapy and checking survival rates for cancer patients who receive it,” he says. “The results are promising.”
Cyroblation therapy improves lives of people with chronic pain
David Prologo, M.D., associated with Emory University School of Medicine’s Division of Interventional Radiology, has focused his research on helping patients who are experiencing chronic pain. He has found notable success in treating patients who have painful cancers, phantom limb pain and more by using image guidance to deliver cryoablation therapy.
“In our ‘day job’ as interventional radiologists, we traditionally perform treatments with percutaneous probes to deliver therapies to targeted areas,” he says. “But in cryoablation therapy, we use probes and image guidance to target nerves and deliver a freezing ablation to deaden the pain.”
Prologo says that the true innovation of the treatment is due to the marriage of existing technologies.
“Interventional radiologists were already using the probes for other procedures, and image guidance was being used for other conditions like biopsies and trauma injuries,” he says. “By using these same tools to address painful conditions, we have been able to offer unique options for patients whose pain has been essentially deemed untreatable in the past.”
Usually guided by a CT scanner, cryoablation therapy is delivered via a 17-gauge needle, through which Argon gas flows to create an ablation zone of cold. Wherever the needle is placed, that ablation zone is formed.
Prologo says the number of applications that can be successfully treated with cryoablation therapy continues to expand.
“We’ve found it helps people who suffer from neuralgia, phantom limb pain, neuropathies, back pain and pain related to spinal cord injury,” he says. “But the granddaddy of them all is cancer pain. People with metastatic cancer can get relief with this treatment.”
Prologo adds that he would like to get the word out to amputees and veterans that cryoablation therapy can help them with the phantom limb pain they experience.
“We know that in the U.S. today, there are at least 2,000 amputees from war in the past 10 years. In our practice, we’ve seen a few veterans, but not nearly the number in our area that suffer from phantom limb pain,” he says. “We haven’t been able to reach these veterans the way we’d like. So we’re applying to the Department of Defense for grant funding in order to perform this procedure for our veterans in need.”
To date, Prologo and his colleagues have treated more than 200 patients using percutaneous palliative cryoablation, but he says that it is not known yet whether the effects are permanent.
“The therapy is so new that we don’t know the long-range effects yet,” he says. “But it appears to be long-lasting.”