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WHAT IS the FUTURE of INTERVENTIONAL ONCOLOGY? Interventional Radiologists Discuss Current and Future Needs to Make IR the Next Pillar in Cancer Treatment

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WHAT IS the FUTURE of INTERVENTIONAL ONCOLOGY? Interventional Radiologists Discuss Current and Future Needs to Make IR the Next Pillar in Cancer Treatment Supplement to Sponsored by Boston Scientific Corporation September 2016 WHAT IS THE FUTURE OF INTERVENTIONAL ONCOLOGY? Interventional radiologists discuss current and future needs to make IR the next pillar in cancer treatment. Theresa Jin-Wook Ryan Kelvin Edward Caridi, MD Chung, MD Hickey, MD Hong, MD Kim, MD Edward David Sam Manfred Sarah Wolfgang Lee, MD Liu, MD Mouli, MD Spanger, MD White, MD DIREXION™ Torqueable Microcatheter REPOSITION WITHOUT THE WIRE With best-in-class torque and four tip shape options, the Direxion Microcatheter allows you to re-position the distal tip without a guidewire and facilitate navigation to additional treatment sites. DIREXION™ DIREXION HI-FLO™ CAUTION: Federal law (USA) restricts this device to sale by or on the order of a physician. Rx only. Prior to use, please see the complete “Directions for Use” for more information on Indications, Contraindications, Warnings, Precautions, Adverse Events, and Operator’s Instructions. INTENDED USE/INDICATIONS FOR USE: The Direxion and Direxion HI-FLO Torqueable Microcatheters are intended for peripheral vascular use. The pre-loaded Fathom and Transend Guidewires can be used to selectively introduce and position the microcatheter in the peripheral vasculature. The microcatheter can be used for controlled and selective infusion of diagnostic, embolic, or therapeutic materials into the vessel. CONTRAINDICATIONS: None known. WARNINGS: • Never advance or withdraw an intravascular device against resistance until the cause of resistance is determined by fl uoroscopy. Movement of the microcatheter or guidewire against resistance may result in damage or separation of the microcatheter or guidewire tip, or vessel perforation. • This Direxion Microcatheter family is not intended for use in the coronary vasculature or neurovasculature. • The Direxion HI-FLO Microcatheter is not designed for the delivery of embolic coils. • Use of excessive force to manipulate the microcatheter against resistance can cause a fracture in the nitinol shaft. Take care not to over-torque the microcatheter, and to relieve any tension before withdrawal by rotating the microcatheter in the opposite direction. PRECAUTIONS: • This device should be used only by physicians thoroughly trained in percutaneous, intravascular techniques and procedures. • Do not introduce the microcatheter without guidewire support as this may cause damage to the proximal shaft of the catheter. • Because the microcatheter may be advanced into narrow sub-selective vasculature, repeatedly assure that the microcatheter has not been advanced so far as to interfere with its removal. ADVERSE EVENTS: The Adverse Events include, but are not limited to: • Allergic reaction • Death • Embolism • Hemorrhage/Hematoma • Infection • Pseudoaneurysm • Stroke • Vascular thrombosis • Vessel occlusion • Vessel spasm • Vessel trauma (dissection, perforation, rupture) REV AB Direxion and HI-FLO are registered or unregistered trademarks of Boston Scientific Corporation or its affiliates. © 2016 Boston Scientific Corporation or its affiliates. All rights reserved. PI-195602-AC AUG2016 The Direxion HI-FLO Microcatheter is not designed for the delivery of embolic coils. PI-195602-AC_Direxion_EVT_AD.indd 1 8/19/16 9:42 AM WHAT IS THE FUTURE OF INTERVENTIONAL ONCOLOGY? Sponsored by Boston Scientific Corporation What Does the Future Hold for Interventional Oncology? A collection of projections from interventional radiologists around the world. Edward Kim, MD, FSIR David Liu, MD, FRCP(C), ABR(D), Director, Interventional Oncology CAQ(IR), FSIR Associate Professor of Radiology and Surgery Clinical Associate Professor Division of Interventional Radiology Angiography and Interventional Section Mount Sinai Medical Center Department of Radiology New York, New York, USA Faculty of Medicine Disclosures: Advisory board member for Boston University of British Columbia Scientific Corporation and Biocompatibles Vancouver, British Columbia, Canada (BTG); on the speaker’s bureau for Disclosures: Independent member of board Biocompatibles (BTG) and Philips Healthcare; of directors for Merit Medical; consultant for consultant for Boston Scientific Corporation. Sirtex Medical and Medtronic. As technological advances are made, previous limitations It is a very exciting time for interventional oncology. are being broken. Technically for interventional oncologists, We are in the renaissance of interventional oncology and this may translate to enhancing our ability to get more have experienced rapid advancement in almost every focused with microcatheters and wires, allowing superselec- aspect of our practice. It’s difficult to prophesize about tive catheterizations with greater ease. Imaging guidance what the future holds, but I believe that these three areas hardware and software help physicians to see exactly where have changed or will change our craft: (1) improvements our therapies are being delivered while limiting nontumor in our imaging technologies, (2) the development of new targeting. Radioembolization has accelerated at a rapid rate delivery platforms, and (3) the introduction of immuno- and is becoming more and more incorporated into main- oncology. stream practices as it evolves. Imaging is everything to us, and we now have insights Multidisciplinary teams focusing on disease states are the into tumors that have extended far beyond multiphasic CT future of treating cancer, and interventional oncology needs and digital subtraction angiography. The developments of to be a main player. We provide a range of therapies from time-resolved imaging, new contrast agents, and complex curative to neoadjuvant to palliative. Precision medicine is navigation algorithms have allowed us the precision to one of the most electrifying terms right now, as newer drugs prospectively plan our attack on the tumor. Parenchymal target tumors through things such as biomarkers, check- blood volume (PBV) has the potential to predict the vas- point inhibitors, and multikinase cascades. Interventional cular capacitance of tumors (using conventional or cone oncology may be able to precisely deliver these therapies beam CT), and may give us the ability to optimize the size through potential vectors intra-arterially or potentiate its of particle and intensity of therapy when performing embo- effects through radiation or ablation, inducing an abscopal lotherapy. Three-dimensional fusion or navigation software effect. Hepatocellular carcinoma, metastatic colorectal can- has permitted reductions in contrast, vessel selection (with cer, and metastatic neuroendocrine tumors are the main embolotherapy), and increased efficiency/precision when tumors that are currently well targeted with locoregional performing ablation, all while reducing risks associated with therapies. However, with synergistic effects, many more met- radiation and operator error. astatic diseases may be targeted. Collaboration with other It would be futile to have improvements in imaging subspecialties is the key to advancing treatment for patients. without the ability to get to where we need to go. With VOL. 15, NO. 9 SEPTEMBER 2016 SUPPLEMENT TO ENDOVASCULAR TODAY 3 WHAT IS THE FUTURE OF INTERVENTIONAL ONCOLOGY? Sponsored by Boston Scientific Corporation embolization, our tools are optimized to the vasculature We must address questions regarding the timing and and vulnerability of the tumor: pressure-assisted emboli- sequence of treatments. And we must tease out the com- zation, steerable microcatheters, and purpose-built wires plexities related to patient selection and extent of disease. give us the ability to give what we want, exactly where The future of interventional oncology lies in our abil- we want. With ablation technologies, we now have a veri- ity to transition interventional oncology therapies from table quiver of platforms and advanced planning software being disruptive innovations to the standards of care. This, to predict and confirm treatment. in turn, requires high-level evidence from large and well- Furthermore, the intimate relationship between locore- designed clinical trials. With the help of public and private gional and systemic therapy will play a key role in the resources, we need to unite the community of interven- future of cancer care. The introduction of new classes of tional radiologists and collaborate with our oncology col- systemic therapies, termed immuno-oncologic agents leagues to generate, assemble, and analyze the clinical data (such as PD-1 inhibitors, designed as “check point inhibi- necessary to not only realize but also maximize the poten- tors”) work on the basis of gearing the body’s own immune tial of interventional oncology treatments. system into overdrive, uncovering the cloak that protects the cancer from detection, and triggering the immune sys- tem to attack cancer. With these therapies, increasing the Jin-Wook Chung, MD circulating fragments of the tumor serve as homing signals Professor to the immune system—phenomena that are well recog- Department of Radiology nized with our ablative and embolotherapeutic agents. This Seoul National University Hospital type of activation is recognized anecdotally in the radiation Seoul, South Korea oncology literature (termed the abscopal effect) and could Disclosures: Received research grants from become a cornerstone to cancer therapy, with an essential Guerbet and Biocompatibles (BTG). role for the interventional oncologist. We are getting better at what we do, smarter in the way we are doing it, and stronger in the role
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