FM JANUARY 2019 - digital edition

practitioners play multiple roles,
comments Dr Amar Mukund, Additional
Professor, Institute of Liver and Biliary
Sciences, Delhi. An IR specialist may be
able to block an internal bleeding simply
by putting a needle directly into the
bleeding site without an open surgery.
Similarly, there are cases tackled by IRs
where patients start bleeding postsurgery.
“In fact, IRs can help bridge
the gap in between... It is a subject that
helps all clinicians when they are in a
difficult situation where they can’t offer
anything,” he explains.
From inoperable to operable
Patients with certain liver conditions
are not good surgical candidates. If
surgery is done on such patients, there
IR IS A SUBJECT THAT HELPS
ALL CLINICIANS WHEN
THEY ARE IN A DIFFICULT
SITUATION WHERE THEY
CAN’T OFFER ANYTHING
is a high risk of complications. These
patients have to be treated either with
endoscopy or interventional radiology.
Again, in situations where a patient has
to undergo organ transplantation but
cannot do the surgery immediately, IRs
can offer him some treatment in the
interim so that he can buy time and plan
for the transplant.
Earlier, many patients had just one
option — surgery. Now, IR provides
multi-optional situations, prolonging the
quality time of the patient.
“Many a time, IRs can make an
inoperable patient operable,” says Dr
Hemant Patel, president-elect, Indian
Radiological & Imaging Association
(IRIA). “The role of IRs will increase day
by day.”
For patients referred by clinicians,
IRs do interventions on the brain,
interventions for the abdomen and for
peripheral arteries. Unlike earlier days
EMBOLISATION
AN INDISPENSABLE OPTION
Embolotherapy, which is used
for inoperable haemorrhage
or pre-operative management
of highly vascular neoplasms,
has become an indispensable
treatment option for a variety of
conditions and an integral part of
IR practice.
Radioembolisation or Selective
Internal Radiation Therapy (SIRT),
which combines embolisation
with radiation therapy, is an
endovascular treatment for
primary and secondary liver
tumours
Radioembolisation has
increasingly been considered as a
treatment modality in the West,
especially in Europe.
Data on the safety and
efficacy of this procedure for
the treatment of primary and
secondary liver tumours is
available.
In chemoembolsation,
chemotherapy along with
embolic agents are injected, in
combination, into the tumour.
Currently, the Cardiovascular
and Interventional Radiological
Society of Europe (CIRSE) is
conducting a Europe-wide,
prospective, observational study
to gather data on transarterial
chemoembolisation (TACE)
using LifePearl Microspheres
loaded with irinotecan (LP-IRI) in
colorectal cancer (CRC) patients
with liver metastatic disease.
Called CIREL (CIRSE Registry
for LifePearl Microspheres), it
is expected to provide more
data on the appropriate use of
drug-eluting beads (DEB-TACE)
loaded with the chemo agent
irinotecan (DEB-IRI), helping
avoid unnecessary standard
chemotherapy where possible.
Also, the study may bring in
evidence for applying TACE with
drug-eluting beads earlier in the
disease, besides giving some idea
about the potential indications to
treat patients with TACE.
Already, many clinicians in
the West have started to use
DEB-TACE with irinotecan to
treat metastatic liver tumours.
DEB-IRI is mainly considered as
a palliative option for patients
who have preserved liver function
and performance status with
unresectable chemotherapyresistant
lesions, liver metastases,
beyond second-line treatment.
IRs expect that DEB-TACE
has a substantial potential to
become a standard treatment
in metastatic colorectal cancer
(mCRC), as well.
JANUARY 2019 / FUTURE MEDICINE / 51