What is Interventional Oncology?
In human medicine, interventional radiologists routinely work intimately with oncologists to provide innovative, minimally invasive options for their patients. A similar trend has recently begun in Veterinary medicine to provide multimodal therapies along with surgeons and oncologists forming a comprehensive oncology team for our patients. Interventional oncology can help provide minimally invasive options with low morbidity for patients who have historically had limited options.
Chemoembolization of liver tumors (TACE-transarterial chemoembolization)
Candidates
- Animals with hepatic tumor that are not amenable to conventional surgical excision (typically HCC)
- Tumors that are progressive or at risk or have historically developed a hemoabdomen
- Dogs with limited evidence of systemic spread are preferred as candidates.
Procedure
- Dual phase contrast abdominal CT is required to assess the arterial supply of the mass and help guide subsequent intervention.
- A small incision over the femoral artery is made to allow catheter selection of the main arteries feeding the hepatic mass.
- Arteries are super selected for local delivery as hepatic tumor blood supply is typically 95% arterial vs. normal liver tissue which receives most of its blood supply from the portal system.
- The chemotherapy is mixed with beads and contrast that are sized to allow delivery of the chemotherapy to the capillary bed of the mass under fluoroscopic guidance.
- These beads may also embolization the mass, this reduces the blood supply and causes necrosis of the mass.
Uptake of chemotherapy eluding beads into the hepatic mass in a human 24 hours after transarterial chemoembolization (TACE) shows the extent of uptake directly into the mass.
Post-procedural recovery
- Dogs have a small groin incision and are kept overnight for observation and supportive care.
- Most are discharged the following day.
Preliminary data (per Dr. Chick Weisse)
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- Safe procedure: <10% non-target embolization
- Tumors tend to have altered architecture at recheck CT
- 30% have reduction in size, many have areas of necrosis.
- Increased concentration of chemotherapy to the liver with significantly reduced levels systemically
- Tumors size may be reduced for subsequent surgical resection.
Percutaneous transjugular stenting for caval obstructions
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- Small incision in jugular vein for caval access
- Placement of stent(s) across obstructive lesion.
- Rapid resolution of signs of impaired venous drainage.
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Other oncological interventions offered at ACCESS
- Chemoembolization of non-resectable tumors
- Endoluminal stenting: urethral, ureteral, biliary, tracheal neoplasia
- Caval stenting for heart-based tumors or other cause of caval obstruction
- Intra-arterial chemotherapy: prostatic tumors, bladder tumors
- Cryoablation, thermoablation
- Endoscopic removal of tracheal masses
- Endoscopic removal of esophageal, gastric, colonic and bladder polyps
References: 1. Schlicksup MD, Weisse CW, Berent AC, Solomon JA. Use of endovascular stents in 3 dogs with Budd-Chiari syndrome. J Am Vet Med Assoc. 2009 Sep 1;235(5):544-50. 2. Guan, YS, He, Qing, Wang, MQ. Transcatheter arterial chemoembolization: history for more than 30 years. Gastroenterology Volume 2012, Article ID 480650, 8 pages.
If you would like your client’s pet to be evaluated by a member of our Interventional Radiology / Endoscopy team, please contact our offices to schedule an appointment. The Interventional Radiology / Endoscopy team accommodates emergency referrals during office hours and is on call for emergency surgeries after hours. Your client’s pet can also be admitted through the emergency service 24 hours a day, 365 days a year for stabilization and transfer to our Interventional Radiology / Endoscopy team.
