Interventional oncology was in the spotlight at CIRSE 2023, with more than 30 sessions focusing on the latest data, trends, and cases with guidance from experts. Read on for an overview of the three most popular IO sessions at CIRSE 2023, or click here to browse all IO content from the congress on demand via the CIRSE Library!
As the liver is the most common metastatic site, the treatment of liver cancer received a lot of attention during the congress. S. Boughdad opened this focus session with a presentation on how personalized dosimetry can improve CLM patient outcome. She walked attendees through the criteria needed to perform personalised dose calculation, as well as covering limitations and comparing different methods of personalised dosimetry. She concluded that SIRT is a safe and effective treatment for mCRC, personalised dosimetry is achievable in routine practice, and that some negative trial results combining SIRT and chemotherapy could be due to the absence of personalised dosimetry. She also concluded that CIRT partition model dosimetry is better than BSA, but that prospective trials are needed.
E. Bozzi then presented on dosing radioembolization for HCC. “What can I do from an IR perspective? I’m not doing nuclear medicine.” she began. “I can say that I have to correctly select patients and also must choose the most suitable dosimetry method for specific conditions.” She then elaborated on both of those topics and analysed factors influencing dosimetry in different tumour presentations, such as tumour location, previous TACE, and previous hepatectomy.
M. Smits closed out the session with a presentation on Holmium radioembolization. He highlighted the differences between various types of microspheres, before demonstrating how he performs radioembolization with only Holmium microspheres as opposed to the more usual work-up with MAA and treatment with Y90 combination. He also reviewed current studies and discussed new approaches moving forward. “In conclusion, dose matters! But I also think we need a powerful surrogate, a good particle to predict the treatment dose.”
Another popular focus session honed in on the expanding applications of ablation as well as its future. Up first, And O. Akhan presented on the role of ablation and indications for ICC, literature data supporting ablation in ICC, and tips for safe and effective ICC ablation. Early surgery is the only traditional curative option for ICC, the prognosis for which is very poor; but surgery is not possible in many patients. “In my opinion, in the future we are going to use more and more minimally invasive techniques and combination therapies to treat larger lesions,” he concluded.
G. Narayan spoke on pancreatic cancer. He started by asking for a show of hands how many in the audience treat pancreatic cancer with ablation; only three or so attendees raised their hands, illustrating how new this technique is. Most ablation options for pancreatic cancer are from non-thermal techniques or IRE. Dr. Narayan went on to explain the off-label technique of percutaneous pancreas IRE as well as patient selection, case examples, and evidence from the data. “Prospective and retrospective studies over the last decade have established the safety and multiple studies have indicated a survival benefit.”, he said, concluding “Ablation in pancreatic cancer is a viable local treatment option when used along with current treatment standards. Hopefully we’ll see it as part of the guidelines in the near future.”
C. Sattin presented on prostate cancer, calling in particular for better investigation and expressing her frustration that ablative therapy is only mentioned under warnings in the current guidelines only due to lack of data. E. de Kerviler closed the session with a presentation on the indications, evidence, and future of ablation for breast cancer, concluding that thermal ablation is an option for the treatment of small breast cancer tumours in elderly patients. “It’s your job to promote ablation. You must have your say in the tumour board!” he implored.
T. Dionisio was up first in this session, presenting on the technique for a safe and effective thyroid thermal ablation. She covered different frequently used techniques (radiofrequency, microwave, and laser) and their differences, as well as possible complications, which are nearly always minor. She concluded that all three types of ablation are safe and effective, and that most complications can be avoided through careful planning.
B. Cekic continued with a talk on thermal ablation of benign thyroid nodules, describing current indications and contraindications, clinical outcomes, and identifying the best and worst-suited patients for ablation techniques for benign thyroid lesions
M. Gkeli concluded the session with a contrasting lecture on thermal ablation in malignant thyroid lesions. Minimally invasive techniques for malignant thyroid lesions have been recommended by several societies, including CIRSE (which published 18 recommendations in 2021 in collaboration with the ETA) over the past decade. “The take home message,” she concluded,” is that minimally invasive thyroid techniques have come of age for thyroid malignant lesions worldwide. Optimal ablation techniques and proper indications are the challenge for the future.”
