Diana Wortham Maultsby, RN
Nurses involved in cancer care should be up to date on the growing number of applications for interventional radiology in oncology, since some centers may call upon them to work within the quickly developing area, a speaker suggested during the ONS 37th Annual Congress.
In fact, the oncology nurse’s role is vital in the management of patients receiving such procedures, noted the speaker, Diana Wortham Maultsby, RN, an oncology clinical nurse specialist who works in Asheville, North Carolina as a clinical infusion data consultant for CareFusion, which is based in San Diego, California.
Interventional radiological procedures entail the use of minimally invasive, image-guided, ablative strategies. In oncology, the strategies are typically aimed at reducing tumor volume, preventing cancer progression, and minimizing the risk of new tumor growth in nonsurgical populations with selectively advanced cancers. The procedures include radiofrequency ablation (RFA), chemoembolization, radioembolization, and high-intensity imageguided focused ultrasound (MRIgFUS), Wortham Maultsby said.
The clinical results of interventional oncology can be comparable to those achieved through surgery, and these procedures are often effective options for medically and surgically ineligible patients, she said. They target cancerous tissue while sparing healthy adjacent tissue, and are associated with reduced side effects, lower morbidity and mortality, shorter hospital stays, fewer complications, and improved quality of life when given in conjunction with or instead of traditional treatment approaches. Procedural advantages of such treatments include the ability to identify targets with imaging and reduced resource utilization compared with conventional surgery, Wortham Maultsby said.
Despite these potential advantages and the fact that there are about 6000 interventional radiologists in the United States, public awareness about these types of treatments is low, Wortham Maultsby said. Still, she said, there are a number of organizations developing guidelines and infrastructure to standardize the roles, services, reimbursement, and delivery models of care in interventional radiology. They include the American College of Radiology, The American Society of Interventional and Therapeutic Neuroradiology, and the Society of Interventional Radiology.
Interventions that are image-guided include all thermal and cryoablation procedures and catheter-based delivery of chemoembolization and radioembolization, she said. For example, interventional radiologists commonly deploy embolization, cryoablation, and microwave and transarterial chemoembolization (TACE) for liver, prostate, lung, and gastrointestinal / colorectal cancers.
Wortham Maultsby described more about such techniques:
Radiofrequency thermal ablation (RFA) precisely delivers increasing levels of heat to tumor tissue with the aid of radiographic imaging (ultrasound, CT, or MRI), and the heat causes cell death. Current indications for RFA include liver and metastatic lesions, and the treatment will probably play a role in the management of other primary cancers, including renal, non-small cell lung cancer, adrenal, and breast cancers, as well as painful bone metastases. The technique can be used to treat patients who are otherwise not surgical candidates or who have failed other therapies. As with other interventional radiology techniques, potential advantages of RFA include lower rates of bleeding, shorter recovery times, and minimal side effects.
Cryoablation utilizes a cryoprobe inserted into a tumor to deliver super-cooled gas that freezes the tumor tissue, and thereby achieves cellular death. Cryoablation is reimbursable through health insurance for prostate cancer and, in some states, for liver cancer. Use of cryoablation at other tumor sites, including the kidney and lungs, is considered investigational.
MRIgFUS is being studied for the treatment of breast fibroadenomas and metastatic bone tumors, with promising results in phase III trials.
Interventional vertebral augmentation can be achieved with percutaneous vertebroplasty or kyphoplasty for patients with symptomatic neoplastic and noncancerous vertebral compression fractures. The technique is proven to be as effective in the reduction of overall pain severity and improved mobility as conservative medical management.
When TACE is used to treat liver tumors, the procedure is performed percutaneously in the angiographic suite, and combines intra-arterial delivery of chemotherapy plus embolic agents. Drug-eluting microspheres have been developed for use with TACE, allowing more precise delivery of chemotherapy into blood vessels surrounding the tumor, and giving the provider better control of bead placement for sustained and predictable dosing. Several clinical trials utilizing TACE with microspheres containing chemotherapy or radiation have been performed, with reliable and positive patient outcomes.
In preparation for interventional procedures, most patients can expect to have IV fluids, premedications for symptom management, and either a radial or femoral arterial line for vascularbased approaches, or a probe or needle route for equipment introduction for nonvascular-based interventions to access the targeted treatment site. During the procedure, patients will need monitored sedation and local anesthetic with standard postprocedure care. Patients may need subsequent treatments for inoperable lesions, a decision that is typically made during an evaluation 4 to 6 weeks post-procedure.
Interventional radiology procedures are a burgeoning area in oncology, and professional competency will be needed to meet the growing demand for these treatments, Wortham Maultsby emphasized.
“A multidisciplinary approach—including the nurse—is vital to success,” she said.