The evolution of interventional oncology in the 21st century

Abstract

Interventional oncology (IO) has proven to be highly efficient in the local therapy of numerous malignant tumors in addition to surgery, chemotherapy, and radiotherapy. Due to the advent of immune-oncology with the possibility of tumor control at the molecular and cellular levels, a system change is currently emerging. This will significantly rule oncology in the coming decades. Therefore, one cannot think about IO in the 21st century without considering immunology. For IO, this means paying much more attention to the immunomodulatory effects of the interventional techniques, which have so far been neglected, and to explore the synergistic possibilities with immuno-oncology. It can be expected that the combined use of IO and immuno-oncology will help to overcome the limitations of the latter, such as limited local effects and a high rate of side-effects. To do this, however, sectoral boundaries must be removed and interdisciplinary research efforts must be strengthened. In case of success, IO will face an exciting future.

Figure 1.

Modified and simplified “cancer cycle”, illustrating some immunological effectors (light gray boxes) and potential stimulating (+) or supressing (-) interactions by IO techniques (gray boxes). IO, interventional oncology; MWA, Microwave ablation

Figure 2.

Incidentally found, large solitary tumour in a 55-y-o female. Histology confirmed a G3 sarcomatous hepatocellular carcinoma, baseline MRI (a – c). Initial treatment with two superselective TACE (40 µm particles loaded with 100 mg doxorubicin) resulted in substantial necrosis of the tumor with still some growth in the periphery; asterix (d- f). Sytemic therapy with a proteinkinase inhibitor (sorfenib) was not tolerated and switched to a checkpoint-inhibitor (PD-1 inhibitor, nivolumab). Nivolumab could maintain (g – i) and promote the tumor necrosis, last control study in 5/2020 (j – l). 5 years after initial diagnosis, the patient is still alive without compromized life quality. The asymptomatic, incidentally in 2017 detected Standford type B aortic dissection was not treated yet since the patient refused to any other treatments beside the HCC therapy. HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization. (Left column: T₂W; middle: DWI ADC map; right: T₁W 20 min post Gd-EOB DTPA)

Figure 3.

Hype cycle. Borrowing from the term coined by the Gartner consultant Jackie Fenn for evaluation in the introduction of new technologies: dashed line IO techniques, solid line immuno-oncology. IO, interventional oncology.