Interventional Oncology, the 4th pillar of modern cancer care
Until the late 90s, modern cancer care consisted of three pillars of treatment: surgery (through tumor resection), radiation therapy, and chemotherapy. These pillars address tumors directly, removing or destroying lesions. Although immunotherapy specialists devised ingenious ways to use the patients’ own immune system to better fight cancer, this approach is set to replace conventional chemotherapy, given its clear advantages.
Interventional Oncology (IO) is now considered the fourth pillar of modern cancer care. Interventional oncology is a subspecialty of interventional radiology that focuses on image-guided procedures to deliver endovascular (embolization) or percutaneous (ablation) treatment to identified cancers. It relies primarily on embolization or ablation to destroy tumors. With the paradigm shift towards minimally invasive approaches, IO is taking a more prominent role in the oncology realm, as it is less invasive than traditional methods and approaches, and interventional radiologists often find creative and innovative ways to treat lesions while minimizing the impact of the intervention.
While the surgical resection of tumors usually offers the best long-term therapeutical solution, it is often not possible due to the size, number or location of the tumor(s), not to mention it is always substantially impactful and subject to more complications and a longer recovery time. Some patients may also be too weak to undergo open surgery.
Interventional Oncology thus presents itself as an optimal solution for several different treatment pathways: image guidance can allow for easier tumor access, IO therapies can be used as palliative and/or to shrink tumors and allow for surgical resection (in cases where it was not possible before), and co-treatment is possible, i.e., it becomes possible to combine IO techniques and any other technique from the other cancer care pillars. Overall, IO enables less pain, fewer side effects, and shorter recovery times (sometimes even in an outpatient ambulatory setting).
Consensus Guidelines for the Definition of Time-to-Event End Points in Image-guided Tumor Ablation
A panel of 62 specialists published a report in Radiology, last September 28, aiming at increasing research on image-guided procedures and standardizing patient care in this IO technique, which has seen a rise in adoption, but still lacks established guidelines and standards that are widely adopted and can ensure consistency of outcomes throughout different practices and even between different physicians within the same institution.
The specialists provided IO physicians with guidelines to “uniformly collect, analyze, and report outcomes for patients treated with image-guided tumor ablation.” Several recommendations around patient eligibility, the definition of survival time and outcome definitions, complication rates and adverse events, health economics, and data censoring are given to guide how clinical studies shall be designed.
From the point of view of a robotics manufacturer, we would like to highlight the following key recommendations:
Addressing outcomes per patient, per procedure, or per tumor:
Different parameters should be evaluated on registries, depending on their nature. Survival, recurrence, and progression rates should be assessed per patient, as this has to do with the long-term patient care; procedural complications and costs should be analyzed per intervention, as each case is unique and relies on the disease stage; technical success (local tumor progression, recurrence, or others) should be assessed per procedure and per tumor, while taking in consideration that multiple index tumors may be related and therefore not be independent.
Technical Success, Technique Efficacy, Local Control, and Ablation Confirmation:
It is suggested to employ postprocedural imaging (or its equivalent) to assess these parameters. Specifically for percutaneous ablations, it is recommended that the minimum tumor-free margin is calculated and the assessment to be based on CT-imaging acquired within at least 24h, through rigid and non-rigid image fusion and registration of datasets.
What does this mean for Micromate™ and Interventional Systems?
As a product specifically designed to assist physicians in executing their pre- or intra-operative surgical plan for tissue ablation, Micromate™ plays a crucial role in ensuring technical success and efficacy.
With its submillimeter accuracy and live-imaging capabilities, our surgical platform ensures each needle will be placed exactly where it is designed to be while allowing for positional corrections at any point during or after insertion. This will result in a more effective ablation session and ensure complete lesion coverage and less impact on surrounding tissues.
When used with Angio CT/CBCT, immediate post-operative scans can be taken for intraoperative confirmation of the ablation zone and to assess safety margins. For other imaging modalities, Interventional Systems will soon have its planning and navigation station available, whose proprietary software will enable the physician to load postoperative scans, confirm the outcome of the treatment, and make any complementary treatment or confirmation biopsy onsite.
These accuracy and planning capabilities will ensure that the absolute minimum number of needles for an accurate and safe treatment is used, which is related to the first highlighted recommendation. This is making procedures less expensive and, consequently, more prone to adoption by practitioners while at the same time increasing the patients’ access to better care.
By addressing the currently existing usability and experience constraints, Micromate™ is a tool that removes the technical bias of needle handling and technical alignment skills, allowing physicians to focus on the clinical aspects of treatment, and allowing less experienced physicians to achieve equivalent outcomes to those obtained by more seasoned colleagues.
Interventional Systems is pioneering better patient outcomes by expanding the access to micro-invasive interventions.
