Friday, October 11, 2019 (Miami, FL) —The second day of the Symposium on Clinical Interventional Oncology featured a morning session focusing on therapeutic areas that are positioned to grow.
The session opened with Shivank Bhatia, MD, University of Miami, speaking on prostate cancer, which has for the last three decades been addressed with a standard of surgery, radiotherapy, or active surveillance. There has been no difference in mortality outcomes between those approaches, so choice of treatment is driven by patient preference and risk of complications such as incontinence. A potential role for interventional radiologists in management of prostate cancer is focal therapy, which is based on the treatment of the index lesion, the largest, dominant lesion associated with the highest Gleason grade. Although focal therapy shows promise, many unanswered questions remain, including patient selection, definition of focal therapy, and how to define which lesion to target.
Yolanda C. Bryce, MD, Memorial Sloan Kettering Cancer Center, presented on breast cancer. Interventional treatments for breast cancer include locoregional treatment of primary breast cancer, treatment of oligometastases with ablation, and liver-directed therapy in diffuse disease.
The door to locoregional therapy for breast cancer has been opened by increased early detection that has resulted in smaller size tumors, as well as evolution in assessment of margins that has led to a standard of smaller margins. Regarding oligometastases, five or fewer metastatic tumors may represent a subtype of metastatic breast cancer with a better prognosis and longer expected survival, and prospective randomized trials have showed that external radiation is associated with longer progression-free survival, with a trend for longer overall survival. Liver-directed therapy is also an option, but, “a lot of work needs to be done in this area,” said Dr. Bryce. She noted that radioembolization shows response with a small amount of toxicity.
Raul N. Uppot, MD, Massachusetts General Hospital, explained soft tissue ablation and the tools, techniques, and challenges surrounding several cases. “There is a large opportunity for growth if you can educate your oncology colleagues,” he said. “Ablation of soft tissues and nodes offers minimally invasive targeting of lesions with no good surgical or radiation option.” However, he cautioned the attendees to remain aware of challenges, particularly surrounding critical structures. Techniques such as hydrodissection, serial debulking, nerve monitoring, and bone drilling/cementoplasty are vital to know.
Jonathan R. Strosberg, MD, Moffitt Cancer Center, gave a primer on peptide receptor radiotherapy (PRRT) for the management of metastatic neuroendocrine tumor. Referencing the literature, he explained delayed toxicity, prediction of PRRT response, and situations that are appropriate for PRRT. Dr. Strosberg also presented on hepatic embolotherapies for metastatic neuroendocrine tumors. He concluded that there are likely only minor differences in efficacy and toxicity between bland and chemoembolization. Radioembolization is fairly well-tolerated in the short term, he noted, but carries significant long-term risk, particularly with bi-lobar selective internal radiation therapy. Combining PRRT with radioembolization may increase risk of radioembolization-induced liver disease.
Riad Salem, MD, MBA, Northwestern University Feinberg School of Medicine, gave an overview of the current role of Y90 in the management of metastatic neuroendocrine tumor, including concerns and benefits. He acknowledged that level I data for Y90 does not impart immunity from critique, including about safety concerns, but he said that context and clinical relevance of toxicity matters. Y90, he emphasized, plays an important role in managing neuroendocrine tumor.
A presentation by Alessandro Lunardi, MD, University of Pisa, discussed augmented portal vein embolization, which is feasible and safe, he said. The procedure has low morbidity, with a short hospital stay and no related mortality. Augmented portal vein embolization does not completely exclude other alternative medical treatments. However, there are areas in which more research is needed, such as criteria for patient selection, liver volume, liver function, tissue quality (histology), slow vs fast kinetic rate of hypertrophy, and outcome prediction.
Ziv J. Haskal, MD, University of Virginia School of Medicine, concluded the session by describing approaches to chronic portal vein thrombosis and how the transjugular intrahepatic portosystemic shunt (TIPS) procedure can be incorporated into the care of certain patients. He emphasized that not everyone needs to be treated and that there is both high risk and high return.
About the Symposium on Clinical Interventional Oncology (CIO)
Renowned for its originality, practicality, and focus on improving patient care, CIO, an HMP event, highlights the most viable and sought-after treatments in the rapidly expanding field of interventional oncology. CIO is led by course directors Ripal Gandhi, MD; Ziv Haskal, MD; Constantino Peña, MD; Daniel Sze, MD; and Alda Tam, MD. The program contains a mix of didactic lectures, case presentations and debates between experts, hands-on workshops, and pre-recorded cases woven together with audience interactivity through polling and question and answer sessions. For more information, visit theiomeeting.com.
HMP is the force behind Healthcare Made Practical – and is a multichannel leader in health care events and education, with a mission to improve patient care. The company produces accredited medical education events and clinically relevant, evidence-based content for the global health care community across a range of therapeutic areas. Its brands include Consultant360, the year-round, award-winning platform relied upon by primary care providers and other specialists; Psych Congress, the largest independent mental health meeting in the U.S.; EMS World Expo, North America’s largest EMT and paramedic event; and the Symposium on Advanced Wound Care (SAWC), the largest wound care meeting in the world. For more information, visit hmpglobal.com.