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Transcatheter and Ablative Therapeutic Approaches for Solid Malignancies

Eleni Liapi, Jean-Francois H. Geschwind

From The Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD

Address reprint requests to Jean-Francois Geschwind, MD, Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, 600 North Wolfe St, Blalock 545, Baltimore, MD 21287; e-mail: jfg{at}jhmi.edu

The purpose of this article is to present in a concise manner an overview of the most widely used locoregional transcatheter and ablative therapies for solid malignancies. An extensive MEDLINE search was performed for this review. Therapies used for liver cancer were emphasized because these therapies are used most commonly in the liver. Applications in pulmonary, renal, and bone tumors were also discussed. These approaches were divided into catheter-based therapies (such as transcatheter arterial chemoembolization, bland embolization, and the most recent transcatheter arterial approach with drug-eluting microspheres), ablative therapies (such as chemical [ethanol or acetic acid injection]), and thermal ablative therapies (such as radiofrequency ablation, laser induced thermotherapy, microwave ablation, cryoablation, and extracorporeal high-intensity focused ultrasound ablation). A brief description of each technique and analysis of available data was reported for all therapies. Locoregional transcatheter and ablative therapies continue to be used mostly for palliation, but have also been used with curative intent. A growing body of evidence suggests clear survival benefit, excellent results regarding local tumor control, and improved quality of life. Clinical trials are underway to validate these results. Image-guided transcatheter and ablative approaches currently play an important role in the management of patients with various types of cancer—a role that is likely to grow even more given the technological advances in imaging, image-guidance systems, catheters, ablative tools, and drug delivery systems. As a result, the outcomes of patients with cancer undoubtedly will improve.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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