Studies Look at Innovative Interventional Radiology Techniques

By Matt Phillion

Leading experts in the field of interventional radiology spoke recently about new scientific findings from three studies showing how interventional radiologists are using innovative minimally invasive treatments. The treatments, which will be discussed at the Society of Interventional Radiology 2024 Annual Scientific Meeting, look at innovations in treating prostate cancer, breast cancer, and uncontrolled post-partum hemorrhage.

“Interventional radiologists delivery patient-centered care through targeted treatments, often with less risk, less pain, and shorter recovery times than other surgeries,” says Alda Tam, MD, FSIR, president of the Society of Interventional Radiology.

MRI-guided transurethral ultrasound ablation

Steven Raman, MD, FSIR, professor of radiology, urology, and surgery at the David Geffen School of Medicine at the University of California, Los Angeles, presented the results of five-year outcomes after MRI-guided transurethral ultrasound ablation (TULSA) of localized prostate cancer, a minimally invasive treatment using MRI and transurethral ultrasound instead of surgery or radiation for treating prostate cancer.

“Prostate cancer is the second-leading cause of cancer death among men in the U.S.,” says Raman. “Traditional methods include radiation and surgery, and although it’s gotten better, these come with a high risk of side effects, including incontinence, erectile disfunction, and loss of bladder control. Although the treatments are effective for cancer control, they can be debilitating.”
TULSA, Raman explains, combines MRI with ultrasound tech in a novel therapy in which a small catheter is inserted through the urethra into the prostate, and using MRI guidance, places elements into the prostate that emit ultrasound energy. These elements are then heated to 55 degrees to target the cancer.

“The five-year outcomes have just been released, which look at 115 men who received this treatment,” says Raman. “The results saw improved reduction of the presence of cancer in the prostate with undetectable levels in follow-up biopsies of 76%.”

Sustained decreases lasted for five years.

“The best news is that TULSA had very favorable side effect profiles compared to other therapies, including other thermal therapies,” says Raman. “It far exceeds other therapies.”

Currently, Raman notes, there are very few interventional radiologists doing prostate cancer care, but this study provides an attractive option for intervention and follow up.

“There’s an opportunity to ply our skills with a verity of other techniques,” he says.

Breast cancer recurrence after cryoablation

Next, Yolanda Bryce, MD, resident in the interventional and diagnostic radiology program at Michigan State University/Corewell Health discussed a study on a minimally invasive technique using ice to freeze and destroy cancerous tumors in breast cancer patients providing a new treatment path for those who are not candidates for surgery.

“Most people today know someone who has been impacted by breast cancer,” says Bryce. “As interventional radiologists we’re looking to expand options to manage their conditions.”

Typically, a multi-treatment approach is used, but surgery is a cornerstone of that treatment, Bryce says.

“A lot of patients are not surgical candidates or refuse surgery—the population is very challenging to the standard of care,” says Bryce.

Cryoablation offers another option. It is minimally invasive and within minutes can be used to freeze and destroy tumors.

“Our study explored the effectiveness of cryoablation for larger tumors. The average size was 2.4 cm,” says Bryce.

Using image guidance from ultrasound, tumors are located and using needle-like probes, smaller than biopsy needles, the probe can create an ice ball that encompasses the tumor and destroys tumor cells. If the tumor regrows, the procedure can be repeated.

The retrospective study looked at 60 patients who underwent cryoablation who were poor candidates for surgery or refused surgery, with the tumors ranging from .3 to 9 cm in size.

“In our technique, we used multiple probes as indicated. If the tumor was larger than 1.4 cm we added a probe for each centimeter of the tumor,” says Bryce.

The recurrence rate in these patients was 10%.

“This is significant because a lot of these patients, had they been candidates for surgery, would have been offered a mastectomy, not a lumpectomy,” says Bryce. “We’re optimistic this can be another treatment option.”

Recovery for this treatment, Bryce says, involves a few days of swelling, in part due to the need to inject fluid into the breast to protect the skin from being injured by the ice. Bruising may also result, as well as lumps in the area of cryoablation resulting from inflammation that turns into scar tissues. Recovery is usually within a week, but the treatment does not require hospital admission.

Bryce discusses next steps for the research, including longer follow-up periods and establishing durability for control.

“We will continue to look at how long cryoablation is effective in patients and continue to look at our data to understand when and if these tumors come back,” she says. “I hope that it will be the case that this is equivalent to a lumpectomy. We hope to do more analysis of how to best help these patients.”

Treatment of uncontrolled post-partum hemorrhage

The third study discussed looks at short- and long-term outcomes of uterine artery embolization for the treatment of uncontrolled post-partum hemorrhage. The second-leading cause of pregnancy-related deaths for women in the U.S., early intervention in these cases with a minimally invasive treatment can save lives, help women avoid hysterectomies, and other serious complications due to severe bleeding after childbirth, notes Younes Jahangiri, MD, resident in the interventional and diagnostic radiology program at Michigan State University/Corewell Health.

“The common solution for uncontrolled post-partum hemorrhage is a hysterectomy, but other treatments can be just as effective as hysterectomies while preserving the uterus,” says Jahangiri. “Uterine artery embolization, or UAH, can help women avoid a hysterectomy due to severe bleeding after childbirth.”

Uncontrolled post-partum hemorrhage is a rare but potentially deadly complication, for which obstetricians will often use a conservative approach to replace lost blood or improve clotting. With UAE, interventional radiologists inject tiny particles into the arteries that supply blood to the uterus using fluoroscopic imaging guidance that temporarily block blood flow to stem uterine bleeding. The study looked at 66 patients who underwent UAE for uncontrolled post-partum hemorrhage.

“UAE successfully controlled post-partum hemorrhage in 61 of 66 patients, or 92%,” says Jahangiri. “Five patients required hysterectomies to stop the bleeding.”

The study found a 36% incidence of post-embolization syndrome, which involves abdominal pain and flu-like symptoms, but these symptoms did not require additional intervention and could be mostly self-controlled. This was most likely amongst patients who experienced greater amounts of blood loss before embolization.

The results of the study show that earlier intervention was important as the more blood the patient loses, the harder the encounter state becomes to control.

“We believe this treatment can make a difference for many women,” says Jahangiri. “UAE has shown effectiveness in controlling post-partum hemorrhage while allowing for future conception and fertility. It can be a big player both for controlling bleeding and preserving the uterus.”

Jahangiri notes that while uncontrolled post-partum hemorrhage is the second-leading cause of death in the stage after childbirth in the U.S., it is an issue around the world.

“We have a maternal care crisis,” Tam adds. “There is a movement to rain interventional radiologists in countries where it hasn’t been done before, and the impact on maternal mortality across the board is an extremely important discussion.”

For more information on the Society of Interventional Radiology’s 2024 meeting, visit here.

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.