Development of a Research Agenda for Interventional Oncology: Proceedings from an Interdisciplinary Consensus Panel

Abstract

INTERVENTIONAL specialties including interventional radiology have been responsible for the innovation, validation, and dissemination of numerous procedures and technologies that have impacted the practice of medicine. The universal endorsement of such established techniques as coronary and peripheral angioplasty (1,2), transjugular intrahepatic portosystemic shunts (3), and uterine fibroid embolization (4,5) has been predicated on the translational research skills of numerous scientists investigating minimally invasive techniques, allowing the advancement of initial conceptual hypotheses toward research trials and subsequently into clinical practice. Within the past decade, there has been evolutionary research and clinical interest in the ability to combine minimally invasive interventional radiologic techniques with multiplanar and functional imaging as a tool to guide organ-specific cancer treatments (6–10). These techniques, collectively referred to as image-guided intervention (IGI) or interventional oncology (IO), have the theoretic appeal of allowing enhanced target-specific therapy for patients with limited or single-organ–dominant disease while potentially minimizing the expectant risks and systemic effects of alternative therapies. In addition, locoregional therapies may also play an important role by providing adjuvant or neoadjuvant therapies to palliate the effects of a malignancy, potentiate other treatments, or prevent untoward effects of systemically targeted therapies, ie, limit organ-specific toxicity with use of catheter-based methods to protect the organ at risk. Concomitant with the growth of IGI, numerous areas of potential further investigation have surfaced. Broadly speaking, several of the more prominent future research issues include (i) systematic assessment of the role of existing and emerging molecular and functional imaging modalities to guide or assess interventions; (ii) use of combinations of existing therapies; (iii) evaluation of existing, novel, or nascent biologic and pharmaceutical agents for catheter-directed regional delivery; and (iv) use of IGI for palliation or ancillary treatment of malignancy-associated processes or paraneoplastic phenomena. To further develop these topics and to identify a research agenda for IO, an interdisciplinary meeting of prominent experts in the fields of interventional radiology, cancer research, and medical oncology was convened in September 2002. The meeting was sponsored by the National Cancer Institute (NCI), National Institute of Biomedical Imaging and Bioengineering, American Cancer Society, American Association of Physicists in Medicine, Cardiovascular and Interventional Radiology Research and Education Foundation, and American College of Radiology Imaging Network. This report summarizes the results of that meeting.