Interventional Radiology


Interventional radiology (IR) can be used to locally treat FLC tumors without major surgery.

In this video from Roswell Park Comprehensive Cancer Center, Michael Petroziello, MD gives an overview of interventional radiology

Interventional radiologists can reach virtually every organ in the body by inserting small needles, wires or catheters through tiny incisions in the skin. IR doctors use medical imaging techniques, such as ultrasound, CT and MRI, to guide their instruments to the precise location of a tumor. As a result, doctors can complete a procedure or give treatment right where a patient needs it. Some of the benefits of interventional radiology include a reduction in the cost, recovery time, pain, and risk to patients who would otherwise need traditional open surgery.

IR techniques used in FLC

Interventional radiologists use a variety of techniques to treat cancers like FLC. These include:

Ablation is sometimes used to treat specific tumors or alleviate symptoms. Liver ablation is often done when the tumor can’t be removed surgically, when the patient is too sick for surgery, or to buy time while the patient is awaiting a transplant.

This video from oncolex describes how radiofrequency ablation is used to treat liver tumors

In liver ablation, a tumor (generally under 3 cm, or just over one inch) is destroyed without being removed.  There are several ablation techniques used to destroy the tumor, including

  • Radiofrequency ablation – the use of high-energy radio waves to heat the tumor
  • Microwave ablation – the use of electromagnetic waves to heat the tumor
  • Cryoablation– freezing  the tumor
  • Ethanol ablation – also called percutaneous ethanol injection (PEI). In this procedure, concentrated alcohol is injected directly into the tumor to damage the cancer cells.

During ablation therapy, heat or cold is transmitted from a special machine through a needle-shaped probe placed into the tumor. With the guidance of an ultrasound or a CT scan, the doctor inserts the probe through the skin and into the liver and the tumor. Imaging is also used throughout the procedure to monitor the treatment and determine whether the approach is helping to destroy the tumor tissue.

Because ablation often destroys some of the normal tissue around the tumor, it might not be a good choice for treating tumors near major blood vessels, the diaphragm, or major bile ducts.

Ablation is not a major surgery, although general anesthesia may be used.

Embolization can also be used as a treatment option when FLC can’t be removed by surgery. Embolization is a procedure that cuts off the blood supply to a tumor by injecting particles directly into the blood vessels feeding the tumors. Since blood carries oxygen and nutrients that are necessary for tumor growth, restricting the blood flow can significantly slow down or stop tumor growth.

In liver embolization, small particles or beads are injected into the hepatic artery. During the procedure, a doctor places a catheter into an artery in the thigh and threads it up into the hepatic artery, using imaging techniques to guide the catheter to the appropriate location. Once the catheter is in the correct place, the doctor injects the beads to block the artery.

Embolization is often used to administer chemotherapy or radiation. The principal types of embolization that are used as FLC treatments include:

This video from Stanford Hospital outlines the use of chemoembolization for liver cancers
  • Transarterial Chemoembolization (TACE). In TACE or chemoembolization procedures, a high dose of cancer-killing drug (chemotherapy) is delivered directly to tumor while depriving the tumor of its blood supply by blocking the arteries that feed it. In these procedures, the chemotherapy is delivered to the tumor either by direct injecting the drug through the catheter, using a gelatin sponge soaked in the drug, or using special drug-eluting beads that already have the chemotherapy in them. This type of treatment can allow a higher amount of the drug to reach the tumor with fewer side effect than systemic chemotherapy. This is because the beads or embolizing agents keep the chemotherapy drug contained in the tumor by blocking the flow to other parts of the body. Consequently, a higher dose of chemotherapy drug can be used, because less of the drug is able to circulate to the healthy cells in the body.
This overview of SIRT produced by SIRTeX, a supplier of Y-90 radioactive beads, gives a useful overview of the procedure for liver cancer patients
  • Transarterial radioembolization (TARE), also called selective internal radiotherapy (SIRT). This form of treatment is a type of brachytherapy, or internal beam radiation. It has the advantage of delivering a high dose of radiation to a very targeted area. This method is very similar to chemoembolization, but instead of using chemotherapy drugs, it uses radioactive glass beads. In TARE, tiny microspheres containing yttrium 90 (Y-90), a radioactive isotope that kills cancer cells, are injected into the artery supplying the tumor. After being infused, the beads lodge in the blood vessels near the tumor, where they emit small amounts of radiation to the tumor site over several days. Because the radiation travels only a short distance, its effects are mainly limited to the tumor.

In general, embolization has relatively few side effects because the anticancer agents are contained near the tumor and don’t travel throughout the body.

This video from Inova Health System describes how the NanoKnife, a type of irreversible electroporation system, can be used to destroy liver tumors

Irreversible electroporation (IRE) is a new technology that destroys tumors with short electrical pulses without thermal heat. The principal advantage of IRE is that it can potentially be used on tumors that are near critical structures, such as arteries, veins, and bile ducts, without doing damage to the healthy tissue.

In IRE, doctors insert one or more thin probes into the tumor and deliver short electrical pulses into the tumor. This creates small holes within the cancer cell membranes, which can lead to tumor cell death. IRE is sometimes used along with surgery to increase the margins for resectable tumors. When tumors are located near major blood vessels, there can be a risk of impacting healthy body parts located along the edges or margins of the tumor. By using IRE before performing surgery, it may be easier to remove the tumor without damaging the healthy tissue.

IRE procedures are sometimes referred to as “NanoKnife” procedures, after the brand name of an IRE-based ablation system.

Please note: The Fibrolamellar Cancer Foundation does not provide medical advice or recommend any specific organizations or services. We provide website users with information to help them better understand their health conditions and current approaches to the diagnosis and treatment of FLC. Always seek the advice of your physician or other qualified healthcare providers.