IR Frontiers

[davidjones]

First off, super glad I found this forum, nice to see so many people interested in clinical IR.

Just wanted to see if anyone has had any experience with the following:

pancreatic islet cell transplants into portal vein (only places I've heard of them being done here is at MUSC and U of Minnesota)

intra-arterial chemotherapy for retinoblastoma and ocular melanoma

TACE for pediatric liver tumors, particularly hepatoblastoma

Any other pediatric interventional oncologic procedures

TACE/radioembolization of advanced stage gyn cancers

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[Gvataken]

Interesting questions.

David, I participated in some islet cell infusions when I was a resident in Chicago. However, have not heard much since then.

As far as ocular melanoma (it often may present with liver dominant metastases and so U of Jeffersion and Dr. Sato have some interesting protocols including BCNU chemoembolization, immune modulated embolization. Also you should check out delcath. They are doing isolated hepatic perfusion of liver metastatic disease with some promising results. Infusion via hepatic artery and occlusion balloons in the IVC at/above hepatic veins and below hepatic veins with high dose chemotherapy infusion.

I have treated some peds patients with metastatic neuroendocrine tumors to the liver, however, I have not treated hepatoblastoma.

As far as some of the other novel treatments sounds interesting.

Check out this month's issue of jvir and the treatment of prostatic BPH by embolizing the prostatic artery.

Hopefully you will be at the SIR, where we have a record number of radiology residents who will be at the chicago meeting and many of those embrace clinical IR.

 

[Gvataken]

http://www.delcath.com/

Here is the website on this relatively new treatment for hepatic dominant tumors (primary or metastatic). Very interesting. Saw the inital presentation at the CIO meeting in Miami.


I have performed isolated limb infusions with actinomycin D and melphalan in patients with limb melanoma and squamous cell carcinoma to prevent limb amputation. This hepatic perfusion is a similar concept where you infuse chemo at very high concentrations only in the organ of interest and isolate it from the rest of the body with occlusion balloons etc. Then, once you infuse it for say an hour you remove all that chemotherapy and resume inflow and outflow to the organ.

 

[davidjones]

alas I squandered all my conference time and vacation for this year and can't make SIR. But will definitely be there next year and will watch the podcasts this year.

How effective were those treatments in limb salvage?

 

[Gvataken]

Isolated limb infusion had a pretty high partial response rates and lesser complete response rates. But, having said that the amputation free rate is good.

Too bad you can't make the annual meeting. SIR has a 3 day curriculum specifically for trainees including a day set aside for medical students. next year it is in San Francisco.