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Interventional Radiology in Oncology

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Interventional Radiology in Oncology

“Interventional Oncology”, which has entered our lives as a result of the development of new technological methods in cancer treatment recently, is the subgroup of Interventional Radiology that deals only with cancer. Directed by Prof. Murat Cantaşdemir, MD, the Interventional Radiology, Interventional Oncology, team performs most of challenging oncological interventions with high success rates.

Diagnostic biopsies and current targeted treatment methods of many cancers such as kidney, lungs, pancreas, liver cancers and liver metastases may be performed through Interventional Oncology.

At the Comprehensive Oncology Center (COC), a board of experts, the multidisciplinary Tumor Board, discuss and collaboratively decide on targeted treatment protocols according to patient needs (called personalized treatment approach). Both Interventional Radiology and Nuclear Oncology take part through all phases of definite diagnosis, treatment, and follow-up of our cancer patients.

What do we do for cancer treatment?

At the Center for Interventional Radiology in Comprehensive Oncology Center (COC) at the Group Florence Nightingale Hospitals, we aim at cancer cells to prevent division and reproduction by forming DNA breaks in the cellular cores by using ionizing X-rays.

In the modern approach to oncological treatment, Interventional Oncology occupies an important place. With targeted chemoembolization, radioembolization and tumoral ablation, the chances of destroying cancerous tissue are increasing.

Applications in our field are:

• Liver cancer (cirrhosis related cancer, hepatocellular carcinoma-HCC),

• Hepatic metastases (breast, large intestine (colon), pancreas, stomach, lung, neuroendocrine, etc. metastases to the liver)

• Cholangiocarcinoma (biliary tract cancer)

• Kidney cancer,

• Pancreatic cancer,

• Lung cancer,

• Bone cancer and bone metastases,

• RF ablation,

• MW Microwave ablation,

• Cryoablation,

• IRE ablation,

• HIFU ablation,

• Radioembolization, microsphere therapy, Yt-90

• Chemoembolization,

• Chemosaturation, PHP

• Solid organ biopsies (i.e. pancreas, breast, liver)

What do we offer at the Center of Interventional Oncology (Radiology)?

Interventional Oncology is a side-branch of Interventional Radiology that mainly incorporates advanced and minimally invasive loco-regional cancer treatment methods. The treatments are carried out under the guidance of “imaging methods” including Digital Subtraction Angiography (DSA), Computed Tomography (CT), Ultrasonography (USG) and Magnetic Resonance Imaging (MRI). Interventional Oncology requires a healthcare organization with robust physical conditions and technological infrastructure, and a good teamwork. Advanced and minimally invasive cancer treatment methods of Interventional Oncology consist of Tumoral Ablation, Chemoembolization, and Radioembolization.

Tumoral Ablation is mainly used in the treatment of liver, renal, lung, and bone tumors.  The procedure of tumoral ablation is entering into the cancer tissue with a special needle through the skin under the guidance of CT and/or USG. This special needle in the cancer tissue creates ”Thermal Damage” that results in the death of cancer cells by burning or freezing them. Tumoral ablation is not a surgical procedure, and it does not require any incision or suture.  Previous studies showed evidence that its efficacy is high and comparable with surgical methods.

Chemoembolization is mainly used in the treatment of liver cancer, i.e. hepatocellular carcinoma-HCC, intrahepatic cholangiocarcinoma (ICC), and liver metastases in cases of who are not suitable to surgery and are refractory to chemotherapy. The procedure of chemoembolization is injecting microspheres containing chemotherapy drugs into the cancer feeding vessels under the guidance of Digital Subtraction Angiography (DSA). These microspheres emit chemotherapy drugs into the cancer tissue that results in the death of cancer cells. A very little amount of chemotherapy drugs enter into systemic circulation with significantly less side effects than systemic chemotherapy. In addition, the feeding vessels of the cancer tissue are closed to ensure that the cancerous tissue does not get any nutrition and oxygen. Chemoembolization is not a surgical procedure, and it does not require any incision or suture. Previous studies showed evidence that its efficacy is high; it prolongs life expectancy of liver cancer patients and patients with liver metastases.

Radioembolization is mainly used in the treatment of liver cancer, i.e. hepatocellular carcinoma-HCC, intrahepatic cholangiocarcinoma-ICC, and liver metastases in cases of who are not suitable to surgery and are refractory to chemotherapy. The procedure of radioembolization is injecting microspheres containing radioactive material (Y90 radioisotope) into the cancer feeding vessels under the guidance of Digital Subtraction Angiography (DSA). These microspheres emit radioactive particles into the cancer tissue that results in the death of cancer cells. Radioembolization is not a surgical procedure, and it does not require any incision or suture. Previous studies showed evidence that its efficacy is high; it prolongs life expectancy and increases quality of life of liver cancer patients and patients with liver metastases. In addition, patients usually do not stay away from chemotherapy and some patients may be able to reach the level of surgery and/or liver transplantation by down-staging strategy of radioembolization.

Our High-tech Radiotherapy Devices

With IMRT (Intensity Modulated Radiotherapy), the radiation dose is formed to the target volume, while the dose taken by normal tissues is reduced. It is also possible to give different doses to different treatment volumes on the same day, which is called Simultaneous Integrated Boost (SIB). Dose staining technique with SIB can be used in many areas such as gynecological and gastrointestinal tumors, except for head and neck tumors.

IGRT (Image Guided Radiation Therapy), is a type of conformal radiotherapy. Conformal radiotherapy shapes radiation rays according to the form of cancerous tissue.

IGRT takes computed tomography images using X-rays (before and during treatment). X-ray and tomography images show the position and shape of cancerous tissue along with the surrounding bone and soft tissues. Doctors plan radiotherapy to give cancer a high dose.

It is very important that the radiotherapy site covers all cancerous tissue and the boundaries around it. This radiotherapy helps to cure cancer. Doctors try to give the surrounding healthy tissue the least possible dose to reduce the risks of side effects.

RapidArc, stands for Volumetric Density Adjusted Arc Therapy (VMAT) and is an irradiation method that can perform radiotherapy with density adjustment, guided by imaging methods very quickly.

If 2-3 minutes of irradiation time is added to the image retrieval time that is less than 2 minutes in RapidArc, the entire daily treatment ends in a total of 4 minutes. With one or more circular rotation of the device around the patient, this technique provides more precise and high dose irradiation of the tumor while adjacent normal tissues protection is ensured. Another advantage of RapidArc over other devices that can apply the intensity tuned radiotherapy technique is secondary cancer that can develop rarely due to radiotherapy by giving less monitor units is to minimize the likelihood.

TrueBeam STx, is an advanced radiotherapy device. It is often successfully used in the treatment of tumors in hard-to-reach areas. What makes TrueBeam STx different from similar technologies is that thanks to its ability to reach high dose speed, it is able to deliver a higher dose in much less time, and therefore significantly is that it provides high performance treatment processes that reduce.

The most important advantage of TrueBeam STx is that it is comfortable, has a high accuracy and precision towards the target. It is an ideal method for treating tumors of different types that are at sensitive points.

With TrueBeamStx, tumor location is determined with 3D images taken before and during treatment, and radiation is enabled to target tumor continuously. Tumors are usually not properly shaped. TrueBeam STx shapes the rays to match the shape of the tumor, so that the solid tissue around the tumor takes less doses.

It is especially preferred in the treatment of tumors adjacent to small volumes and risky organs in the brain and the whole body.

The Real-time Position Management (RPM) system is a non-invasive video based imaging system. With this system, quality images can be obtained in the lungs, breast and upper abdomen areas.

The system is a reliable, easy to use and fast system. The comfort of application is high for patients and allows both breathing and free breathing protocol to work.

With RPM system, the patient can monitor the changes in the respiratory phases of the tumor movement. A cubic plastic box placed on the patient’s sternum or abdominal wall with reflective signs is monitored by an infrared camera, followed by the computer by the graphic of the respiratory phases.

The treatment device is set to give a beam in the selected respiratory phase. When holding deep breath in the treatment of the left side breast, the lung swells, removing the heart from the chest wall, so that doses received by the heart and the left descending coronary artery are decreased during breast irradiation. Left-side breast treatment in our clinic is carried out during deep breath retention under RPM control.

The RPM system can also be used during treatment of the lungs, liver and pancreas.

Gamma Knife is an advanced method of a radiosurgery used for many years in the treatment of diseases of the brain.

The most recently developed Gamma Knife PERFEXION is the replacement or updating of earlier models beyond packed with features. With PERFEXION higher treatment efficacy and fewer side effects can be achieved.

Gamma Knife, a procedure used in the treatment of brain selected targets…

In this method, your doctor does not make an incision with a knife by yourself. Instead of focusing on the highly sensitive gamma rays, the brain directs the target to be treated.

Today, Gamma Knife treatment approximately applied to 65 thousand people all over the world each year.

Gamma Knife treatment process is simple, painless and easy. It takes place in 4 stages:

• Installation of a frame by your doctor

• MR, CT or angiography examinations

• Planning of treatment with high-tech computer

• Gamma Knife Treatment

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Medical tourism has come to prominence in Turkey recently, with a year-on-year increase in the number of foreign patients to choose medical packages that offer a combination of treatment, holiday and transportation. High treatment costs and long waiting lists in some foreign countries have impelled people to look for countries where they can receive high-quality treatment, as well as a visit for a vacation.

Main reasons for selecting Turkey for treatment include:

  • the capacity for high-quality services,
  • comparatively lower prices for the same service in the patient’s home country,
  • well-recognized physicians,
  • high-tech medical technology,
  • Turkey’s reputation as a tourist destination.

Group Florence Nightingale has been at the forefront of the healthcare industry in the region since 1989. Group Florence Nightingale has developed “Centers of Excellence” with expert treatment, surgery and diagnostic capabilities across the Group’s four hospitals and two medical centers, each center gaining recognition in its specialization not only in Turkey but throughout the region.