A Medical Device Daily

Tuesday's conclusion of the annual scientific meeting of the Society of Interventional Radiology (SIR; Fairfax, Virginia), its 31st, in Toronto was marked by a flurry of study presentations.

One of the highlights of the final day at SIR involved a study of uterine fibroid embolization (UFE) to treat post-menopausal women. The data showed that the non-surgical treatment was technically successful in 100% of patients, and improved bulk-related symptoms in 92% of the women.

UFE has been performed by interventional radiologists since 1995 to treat symptomatic non-cancerous tumors in the uterus.

During the technique the physician makes a tiny nick in the skin to insert a catheter into the femoral artery at the groin. Using real-time imaging, the physician guides the catheter through the artery and then releases tiny particles, the size of grains of sand, into the uterine arteries that supply blood to the fibroid tumor. This blocks the blood flow to the fibroid tumor, causing it to shrink and die.

“Although uterine fibroids generally regress after menopause due to the change in hormone levels, there are many post-menopausal women who continue to suffer pain, constipation, urinary frequency and other symptoms caused by their uterine fibroids,“ said study author and interventional radiologist, Robert Vogelzang MD, of Northwestern University Medical School (Chicago). “This research shows that non-surgical uterine fibroid embolization effectively reduces fibroid-related symptoms in post-menopausal women and should therefore be offered as a treatment choice.“

Post-menopausal women have been included in previous UFE studies, but this was the first time the entire cohort had completed menopause. The 24 women in this study were identified as post-menopausal according to the Stages of Reproductive Aging Workshop (STRAW) criteria. The patients' average age was 52. The average follow-up was nine months.

In other reports from SIR:

• Data showed that the combination of non-surgical thermal ablation with radiation reduces severe chronic pain caused by chest wall tumors in 71.4% of patients and the benefit was maintained in 66.7% of the patients who survived to one year.

The new non-surgical techniques studied – radio frequency ablation, cryoablation and microwave ablation – heat or freeze the cancerous cells, killing the tumor and nerve endings in the vicinity that were causing pain. The new interventional radiology treatments offer patients improved quality of life and are easily tolerated. These non-surgical treatments are ideal for those who do not respond to narcotics or radiation, whose pain is worsening with the cancer's growth, or whose treatment options are exhausted. Thermal ablation treatments are a growing area in interventional oncology, a specialty area of medicine within interventional radiology.

“Pain affects more than 60% of patients with advanced cancer. Thermal ablation allows us to reduce a patient's chronic pain non-surgically, improve their quality of life and enable them to live with cancer, all without serious side effects,“ said study author Damian Dupuy, MD, of Brown University Rhode Island Hospital (Providence, Rhode Island). “This research shows these interventional treatments provide quick and lasting pain reduction. Since it is a local treatment that does not harm healthy tissue, the treatment can be repeated as often as needed to keep a patient comfortable.“

The patients in the study were terminal, with a life expectancy of less than one year, and were not surgical candidates. The median age of the 49 patients in the study was 65. Combined, they had a total of 56 symptomatic chest wall masses that were treated with thermal ablation, in conjunction with external-beam radiation therapy. Forty-nine radio frequency ablations, five microwave ablations and two cryoablations were performed.

“These patients have been through so much fighting their cancer. As a physician, it's so gratifying to be able to provide a treatment that is so beneficial to patients and so easy for them to undergo,“ commented Dupuy. “These new interventional treatments offer cancer patients a chance to feel more normal.“

• A study showed that interventional radiologists can treat low-flow vascular malformations in children non-surgically with a laser. In the study, 100% of the laser ablations were technically successful, 96% of the patients had their pain eliminated or reduced, and there were no major complications from the procedure.

Additionally, the new laser technique is less painful for the patient than existing therapies. Venous malformations are spongy, mass-like lesions composed of abnormal veins – veins with a relative lack of smooth muscle cells in their walls. Venous malformations can be visible, causing deformity. Those occurring in the arms and legs can be extremely painful and eventually some cause nerve damage and pulmonary emboli. They are generally treated for pain relief or to prevent pulmonary emboli, which are potentially life-threatening.

Interventional radiologists adapted existing non-surgical laser technology that is already approved for use in varicose veins to treat this vein malformation.

Current treatment involves serial or repetitive sclerotherapy, a procedure in which an irritative solution is injected into the abnormal veins to cause them to shrink. Most patients undergo a series of three to six procedures to treat their venous malformation because the faulty veins re-open and swelling prevents access to the entire malformation. Sclerotherapy is an effective treatment. However, large venous malformations may be difficult to treat with sclerotherapy alone, due to the large amount of the sclerosing solution needed to treat the whole malformation. Complications related to the swelling can occur, and recovery can be prolonged due to pain, especially for venous malformations of the limbs.

During the new treatment, the interventional radiologist uses a laser fiber within a catheter to seal closed the largest abnormal veins. The procedure is not always effective in completely closing the veins, and some patients receive some sclerosant as well. Since the amount of sclerosant injected is less than the treatment using sclerosant alone, there usually is less swelling and pain after the procedure, and faster recovery and return to school and activities.

In the Boston Children's Hospital study, 24 patients' low-flow vascular malformations were treated with 38 endovascular laser ablations, 37 of which were followed with sclerotherapy. The volume of sclerosant was reduced by at least one-third in these patients. The vascular malformations were located on patient's face and tongue, neck, chest wall, upper extremity and lower extremity. Patients were followed up for pain and their imaging studies were compared.