July 31, 2014 8:43 PM

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The Tumor Zappers of Cedars-Sinai

Photo Credit Bill Pollard Cedars Sinai Medical Center

The cavalry has arrived.

A catheter inserted through an artery delivers chemotherapy directly into the tumor, reducing the systemic discomfort of conventional chemotherapy. Agents delivered with the chemotherapy cut off the blood supply and trap the anti-cancer drugs inside the tumor.

Selective Internal Radiation Therapy (SIRT) delivers internal radiation with tiny polymer beads containing radioactive yttrium-90 directly into a tumor in the liver.

Guided by CT scanning technology, a radiofrequency current is passed through a tiny needle-like probe, heating the tumor in the lung, liver or kidney to over 160 degrees Fahrenheit and killing it.

Photo Credit Bill Pollard Cedars Sinai Medical Center

How is this possible?

At Cedars-Sinai S. Mark Taper Foundation Imaging Center innovative, minimally invasive techniques are being used to treat tumors with pinpoint accuracy.  A probe, guided by imaging technology, delivers the “zappers†without the pain, downtime and complications of traditional surgery and without damaging surrounding tissues.

Interventional radiology may not be a household term, but it is the newest specialty for treating many life-threatening diseases, including cancer. Using cutting edge imaging technology, physicians can not only see inside the body, they can use small catheters or other devices to apply treatment directly where it can do the most good with minimal impact on surrounding healthy tissue without further compromising a patient’s health.

“Combining treatment techniques with imaging guidance has allowed us to advance therapies for abnormalities that were previously too small or too inaccessible,†said Barry D. Pressman, M.D., FACR, chairman of Cedars-Sinai’s S. Mark Taper Foundation Imaging Center.

Radiology has long been used as a diagnostic tool. It is now used increasingly in groundbreaking interventional therapy, dramatically changing outcomes for critically ill patients. Cedars-Sinai is a world-class center for state-of-the-art technology in the treatment of cancer.

Angioplasty is a form of interventional radiology most of us are familiar with. The first treatment was delivered with success in 1964. Since then, the science of interventional radiology has grown exponentially. Along with the growth of technology in imaging, the use of interventional radiology has expanded into cancer care.

Three physicians who are on the leading edge of these new therapies are at Cedar’s-Sinai S. Mark Taper Foundation Imaging Center. Thomas J. Learch, M.D. is an attending radiologist and an expert in interventional musculoskeletal radiology.  Peter J. Julien, M.D. is chief of Thoracic Imaging and the director of the Radiofrequency Ablation (RFA) program. Marc L. Friedman, M.D. is chief of Vascular and Interventional Radiology.

Dr. Learch recently performed radiofrequency ablation on a 17-year-old with osteoid osteoma, a relatively rare benign tumor that affects teens and young adults. The pain had sidelined his music aspirations in his rock band and he had trouble sleeping and walking. Instead of invasive surgery that would have a long recovery, the tumor was zapped with radiofrequency ablation. The next day, the patient returned to his normal activities, sans scar, downtime or pain.

For patients suffering from certain types of lung, liver and kidney cancers the standard of care has traditionally been surgery. However, some patients cannot have surgery for their disease. “They are ideal candidates for RFA,†said Dr. Julien.

RFA is a new tool in the arsenal against cancer. The results are extraordinarily promising. It is not indicated for all types of cancer, but for small tumors of four centimeters or less, in the liver, kidney and lung, the results are no less than astonishing.

Typically, surgical treatment of kidney tumors requires either partial or complete kidney removal, resulting in hospital admissions of three to ten days and postoperative recovery time of six to eight weeks. By comparison, RFA is not only minimally invasive with a short recovery time (less than one day) but it also allows for the kidney to be preserved. RFA also avoids postoperative complications such scars, pain, pneumonia and injury to the organs.

For patients who have experienced RFA, said Dr. Julien, “They feel lucky that the cancer was in an accessible location.  They call it ‘a miracle,’†he said. “These patients have renewed hope.  We have had an amazing impact, not only on the destruction of the tumors, but the outlook these patients have on their future.â€

“Image-guided catheter delivery of cancer-killing agents has created a new standard of care in which tumors are treated geographically,†said Dr. Friedman.  In chemoembolization he delivers chemotherapy directly to the blood supply of the tumor in the liver, blocking the blood vessels that bring nutrients to the tumor. In another technique, radioactive beads are delivered through these blood vessels to locally radiate the cancer.  “The beauty of the procedure is that they are usually performed on an outpatient basis, there are no large incisions and patients have a brief recovery time,†said Dr. Friedman.

“For someone who has a tumor originating in the liver, these techniques can allow a patient to remain a candidate for liver transplantation, which represents the only potential cure for their disease,†he said.

“These minimally-invasive techniques are examples of exciting frontiers in interventional oncology,†said Dr. Friedman. “Cedars-Sinai is a world-class institution that offers a multidisciplinary approach to patients with cancer. As interventional radiologists, we work closely with oncologists, surgeons, internists and other specialists to determine the best course of treatment for individual patients.â€

 â€œCedars-Sinai balances academics with primary care very successfully, walking the fine line between teaching and quality research without losing its goal of patient care,†said Dr. Friedman.

 Yes, the cavalry has arrived.  They are the tumor zappers of Cedars-Sinai Medical Center’s interventional radiology team. Through their considerable expertise, performing almost 7,000 minimally invasive procedures per year, they offer new hope to patients with cancer.

For information, visit www.csmc.edu/imaging or the Society of Interventional Radiology at www.sirweb.org

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