Current status of transcatheter management of neoplasms: A surgeon's view

Abstract

Drs. Chuang and Wallace present an overview of an increasingly complex multidisciplinary area that is of interest to medical and surgical oncologists and radiation therapists as well as to radiologists. Interventional angiographic techniques often allow complex, aggressive treatment programs to be carried out in ill patients with limited life expectancies without subjecting these patients to major surgery. I will limit my further comments to the area of the liver malignancies. The authors describe various approaches to the treatment of hepatic neoplasms by arterial occlusions. Central arterial occlusion using a spring device or glue injection, or more peripheral occlusion using Gelfoam embolization may be complementary. Whether such transcatheter techniques are as effective as surgical devascularization of the liver remains unclear. There is little doubt, however, that arterial occlusion can result in tumor necrosis and may be particularly valuable in treatment of patients with hormone-producing metastases, such as carcinoids. It is also intriguing to speculate on the role of hepatic artery thrombosis or peripheral embolization during arterial infusion chemotherapy. In patients who have had long-term infusion chemotherapy via hepatic artery catheters serial angiograms document a high incidence of thrombosis. Future studies involving regional chemotherapy should investigate the arterial status in all patients who have allegedly responded to the infusion chemotherapy. Infusion chemotherapy of liver tumors has usually involved long-term hepatic artery drug infusions. Some surgical oncology groups have been interested in hepatic artery ligation and portal vein infusion, which is an area yet to be explored by radiologists.