Interventional oncology: cutting-edge technology to improve the patient's life

Different image-guided devices integrated into Einstein's routine help in the personalization of care and treatment

Complex diseases such as cancer often require innovative solutions, such as those offered by Interventional Medicine. No wonder, this area has gained a lot of ground because of the advantages it offers to cancer patients, especially those with challenging conditions. And that goes from diagnosis to treatment.

Biopsies, for example, today can be image-guided. Instead of performing more invasive surgery, the physician relies on real-time images generated by ultrasound, CT, or MRI to collect the necessary material through small incisions. “Precision oncology relies on sophisticated analysis of tumor tissue, so biopsies become even more relevant,” says Rodrigo Gobbo, Medical Director for the Einstein Center for Interventional Medicine. This means that the demand for sampling tends to increase – in this sense, Interventional Medicine is able to contribute to more comfort and lower risk of complications.

On the treatment side, there is no shortage of examples of Einstein's innovative performance. "Today, I can insert a kind of needle directly into the kidney cancer and freeze it," illustrates Gobbo. This is cryoablation, a technique with similar efficacy to surgery – and which, again, offers a potentially faster recovery. Faster rehabilitation allows patients to resume other therapeutic strategies earlier.

Another widely debated technique these days is radioembolization for liver metastases. It lies between Interventional Medicine and Theranostics – which shows how close these areas are. It begins with a kind of simulation.

The physician uses a catheter to infuse a low-power radiopharmaceutical (technetium-99m) into arteries near the blood vessels that supply the cancer. Through tests such as scintigraphy, it is possible to check if the molecules are reaching the tumor, or if a significant part is escaping to other regions through small blood vessels. Based on this and other evaluations, the dose and the exact points of insertion of the radiopharmaceutical are defined, as well as other adjustments customized to that patient. This is to maximize efficacy and reduce adverse effects of treatment.

The doctor then applies a more potent radiopharmaceutical (yttrium-90) as tested in the simulation phase. This molecule travels within a microsphere to the smaller vessels located near the cancer. There, through radiation, it destroys tumor cells.

"We are a reference in Brazil in radioembolization, and are working strongly to advance even more in hepatobiliopancreatic diseases"

Rodrigo Gobbo, Medical Director for the Einstein Center for Interventional Medicine.

Another aspect where Interventional Medicine has gained more and more space is in pain management, which affects at least 50% of patients. “Patients often undergo many venipunctures, may have postoperative pain or even the disease itself and its metastases," says anesthesiologist Clarisse Beraldo, manager of the pain area at the company Takaoka, a vendor at Einstein.

When traditional medicines do not do the job, Interventional Medicine can block specific nerves (or modulate them) or install devices inside the patient that release drugs in key regions.

"Something we managed to do at Einstein through Interventional Medicine is to prevent pain that can arise if the cancer reaches a certain structure," says Beraldo. That is: certain tumors usually advance to specific sites, such as a nerve or a ganglion. In view of this, and after performing tests to see if the treatment would bring good results, the interventional physician destroys this structure early and, by doing so, spares the individual from future discomfort.

The interaction between Interventional Medicine and other modern fields of Oncology, in fact, is the subject of much attention today. Studies begin to verify whether interventions such as these, when attacking cancer, generate more antigens that could be targeted by immunotherapeutic drugs, among others. "There are several lines of research with combinations between Interventional Medicine and different drug treatments, and we are already adapting in case this becomes a reality," says Gobbo.

Einstein even has a project to become an isolated organ perfusion center for metastatic melanoma. This is an innovation that uses Interventional Medicine techniques to isolate the circulation of an organ, such as the liver, from the rest of the body. Thus, it becomes possible to apply high doses of a medication only in this place, without it escaping to other parts of the body, which would compromise the effectiveness and generate more adverse reactions.

With the culture of incorporating early technologies like this, which effectively bring benefits, Einstein remains prepared to navigate the wave of innovations in oncology.