Girişimsel Onkolojide Temel Yaklaşımlar
Özet
Girişimsel onkoloji, görüntüleme kılavuzlu minimal invaziv işlemlerle kanserin tanı, tedavi ve semptom kontrolünde önemli yer tutmaktadır. Görüntüleme eşliğinde yapılan biyopsiler histopatolojik tanının temelini oluştururken, ablasyon ve transarteriyel tedaviler lokal tümör kontrolünün başlıca bileşenleri arasında yer alır. Radyofrekans ablasyon, mikrodalga ablasyon ve kriyoablasyon, tümör dokusunda geri dönüşümsüz hücresel hasar oluşturarak etkisini gösteren temel ablasyon teknikleridir. İrreversibl elektroporasyon ise özellikle termal hasarın risk oluşturduğu anatomik bölgelerde, hücre membranında geri dönüşümsüz permeabilizasyon meydana getirerek alternatif bir tedavi seçeneği sunar. Transarteriyel yaklaşımlar, tümörü besleyen damarların selektif olarak hedeflenmesine dayanır; bland embolizasyon iskemik etki oluştururken, transarteriyel kemoembolizasyon yüksek lokal kemoterapötik ajan konsantrasyonu sağlar, transarteriyel radyoembolizasyon ise tümör dokusunda seçici yüksek doz lokal radyasyon etkisi oluşturur. Bu yöntemler, özellikle karaciğer tümörlerinde lokal kontrol, köprüleme tedavisi ve tümör yükünün azaltılması açısından önemli bir yer tutar. Ağrı palyasyonu, malign obstrüksiyonların drenajı ve tümör ilişkili kanamanın kontrolü de girişimsel onkolojinin temel klinik katkıları arasındadır. Sonuç olarak girişimsel onkoloji, küratif, köprüleyici ve palyatif yaklaşımları hasta bazlı planlama çerçevesinde birleştiren kapsamlı bir onkolojik tedavi alanıdır.
Interventional oncology plays a major role in the diagnosis, treatment, and symptom control of cancer through image-guided minimally invasive procedures. Biopsy provides histopathologic diagnosis, whereas ablation and transarterial therapies are central to local tumor control. Radiofrequency ablation, microwave ablation, and cryoablation exert their effects by inducing irreversible cellular injury within tumor tissue. Irreversible electroporation offers an alternative approach, particularly in locations where thermal injury may pose a significant risk, by acting through disruption of the cell membrane. Transarterial approaches are based on the selective targeting of tumor-feeding vessels; bland embolization produces an ischemic effect, transarterial chemoembolization achieves high local concentrations of chemotherapeutic agents, and transarterial radioembolization produces a selective high-dose local radiation effect within tumor tissue. These methods are particularly important in liver tumors for local control, bridging, and tumor burden reduction. Pain palliation, drainage of malignant obstructions, and control of tumor-related bleeding also represent major clinical contributions of interventional oncology. Overall, interventional oncology represents a comprehensive oncologic field that integrates curative, bridging, and palliative strategies within a patient-specific clinical framework.
Referanslar
Abdelsalam ME, Ahrar K, Sheth RA, Shah KY, Yevich S, Gurusamy V, et al. Interventional oncology: A primer for clinicians on the role of ablation and embolization for solid tumors. CA: A Cancer Journal for Clinicians. 2026;76(1):e70051.
Young S, Golzarian J. Locoregional therapies in the treatment of 3-to 5-cm hepatocellular carcinoma: critical review of the literature. American Journal of Roentgenology. 2020;215(1):223-34.
Ahmed M, Brace CL, Lee Jr FT, Goldberg SN. Principles of and advances in percutaneous ablation. Radiology. 2011;258(2):351-69.
Chu KF, Dupuy DE. Thermal ablation of tumours: biological mechanisms and advances in therapy. Nature Reviews Cancer. 2014;14(3):199-208.
Gill AE, Hawkins CM. Introduction to interventional oncology: a COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer. 2023;70:e30234.
Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee Jr FT, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation—what should you use and why? Radiographics. 2014;34(5):1344-62.
Matthew Hawkins C, Towbin AJ, Roebuck DJ, Monroe EJ, Gill AE, Thakor AS, et al. Role of interventional radiology in managing pediatric liver tumors: part 2: percutaneous interventions. Pediatric Radiol. 2018;48(4):565-80.
Brace CL. Radiofrequency and microwave ablation of the liver, lung, kidney, and bone: what are the differences? Current problems in diagnostic radiology. 2009;38(3):135-43.
Kwak DH, Yu Q, Malavia M, Sellers E, Said A, Patel M, et al. Risk factors for abscess development following percutaneous microwave ablation therapy of hepatic tumors. CardioVasc Intervent Radiol. 2023;46(6):726-36.
Littrup PJ, Jallad B, Vorugu V, Littrup G, Currier B, George M, et al. Lethal isotherms of cryoablation in a phantom study: effects of heat load, probe size, and number. J Vasc Intervent Radiol. 2009;20(10):1343-51.
Mafeld S, Wong JJ, Kibriya N, Stenberg B, Manas D, Bassett P, et al. Percutaneous irreversible electroporation (IRE) of hepatic malignancy: a bi-institutional analysis of safety and outcomes. Cardiovasc intervent radiol. 2019;42(4):577-83.
Marelli L, Stigliano R, Triantos C, Senzolo M, Cholongitas E, Davies N, et al. Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc intervent radiol. 2007;30(1):6-25.
Rice SL, Berry-Tony S, Benjamin J, Kapur P, Alnablsi W, Lamus D, et al. The influence of preablation embolization particle size on the size of the microwave ablation zone in a porcine orthotopic renal tumor model. J Vasc Intervent Radiol. 2025;36(1):168-74.
Gunn AJ, Patel AR, Rais-Bahrami S. Role of angio-embolization for renal cell carcinoma. Current urology reports. 2018;19(10):76.
Wáng Y-XJ, De Baere T, Idée J-M, Ballet S. Transcatheter embolization therapy in liver cancer: an update of clinical evidences. Chinese Journal of Cancer Research. 2015;27(2):96.
Lee S, Ghosh A, Xiao N, Gordon AC, Heidarpour N, Funaki B, et al., editors. Embolic agents: particles. Seminars in Interventional Radiology; 2023: Thieme Medical Publishers, Inc.
Li D, Pua BB, Madoff DC, editors. Role of embolization in the treatment of renal masses. Seminars in interventional radiology; 2014: Thieme Medical Publishers.
Vogl TJ, Scheller A, Jakob U, Zangos S, Ahmed M, Nabil M. Transarterial chemoembolization in the treatment of hepatoblastoma in children. European radiol. 2006;16(6):1393-6.
He M, Cai J-B, Lai C, Mao J-Q, Xiong J-N, Guan Z-H, et al. Neoadjuvant transcatheter arterial chemoembolization and systemic chemotherapy for the treatment of undifferentiated embryonal sarcoma of the liver in children. World Journal of Clinical Cases. 2022;10(19):6437.
Lungren MP, Towbin AJ, Roebuck DJ, Monroe EJ, Gill AE, Thakor A, et al. Role of interventional radiology in managing pediatric liver tumors: part 1: endovascular interventions. Pediatric Radiol. 2018;48(4):555-64.
Mahnken AH, Spreafico C, Maleux G, Helmberger T, Jakobs TF. Standards of practice in transarterial radioembolization. Cardiovasc intervent radiol. 2013;36(3):613-22.
Rmilah AA, Qrareya MN, Fleming C, Alkurashi AK, Nyberg S, Leise M, et al. Association of cirrhosis and other patient and procedural characteristics with postembolization syndrome after bland hepatic artery embolization for hepatic malignancy. American Journal of Roentgenology. 2022;218(6):1030-9.
Lee HN, Hyun D. Complications related to transarterial treatment of hepatocellular carcinoma: a comprehensive review. Korean J Radiol. 2023;24(3):204-23.
Hsin I-F, Hsu C-Y, Huang H-C, Huang Y-H, Lin H-C, Lee R-C, et al. Liver failure after transarterial chemoembolization for patients with hepatocellular carcinoma and ascites: incidence, risk factors, and prognostic prediction. Journal of clinical gastroenterology. 2011;45(6):556-62.
Min YW, Kim J, Kim S, Sung YK, Lee JH, Gwak GY, et al. Risk factors and a predictive model for acute hepatic failure after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. Liver International. 2013;33(2):197-202.
Joskin J, de Baere T, Auperin A, Tselikas L, Guiu B, Farouil G, et al. Predisposing factors of liver necrosis after transcatheter arterial chemoembolization in liver metastases from neuroendocrine tumor. Cardiovasc Intervent Radiol. 2015;38(2):372-80.
Braat MN, van Erpecum KJ, Zonnenberg BA, van den Bosch MA, Lam MG. Radioembolization-induced liver disease: a systematic review. Eur J Gastroenterol Hepatol. 2017;29(2):144-52.
Spina JC, Hume I, Pelaez A, Peralta O, Quadrelli M, Garcia Monaco R. Expected and unexpected imaging findings after 90Y transarterial radioembolization for liver tumors. Radiographics. 2019;39(2):578-95.
Woo S, Chung JW, Hur S, Joo S-M, Kim H-C, Jae HJ, et al. Liver abscess after transarterial chemoembolization in patients with bilioenteric anastomosis: frequency and risk factors. American Journal of Roentgenology. 2013;200(6):1370-7.
Jia Z, Tu J, Cao C, Wang W, Zhou W, Ji J, et al. Liver abscess following transarterial chemoembolization for the treatment of hepatocellular carcinoma: A retrospective analysis of 23 cases. Journal of Cancer Research and Therapeutics. 2018;14:628-33.
Nakada S, Allard M-A, Lewin M, Awad S, Dahbi N, Nitta H, et al. Ischemic cholangiopathy following transcatheter arterial chemoembolization for recurrent hepatocellular carcinoma after hepatectomy: an underestimated and devastating complication. Journal of Gastrointestinal Surgery. 2020;24(11):2517-25.
Clark TW. Complications of hepatic chemoembolization. Semin intervent radiol. 2006;23(2):119-25.
Chen Y-F, Lin Z-Y, Chen L-T, Zhang Y, Du Z-Q. Cystic artery embolism after transarterial chemoembolization for hepatocellular carcinoma: A case report and review of the literature. World Journal of Gastrointestinal Oncology. 2025;17(3):99129.
Lin M-T, Kuo P-H. Pulmonary lipiodol embolism after transcatheter arterial chemoembolization for hepatocellular carcinoma. JRSM Short Reports. 2010;1(1):1-4.
Kim H-C, Kim GM. Radiation pneumonitis following yttrium-90 radioembolization: a Korean multicenter study. Frontiers in Oncology. 2023;13:977160.
Dhamija E, Deshmukh A, Meena P, Kumar M, Bhatnagar S, Thulkar S. Complementary role of intervention radiology in palliative care in oncology setting. Indian journal of palliative care. 2019;25(3):462.
Yao PF, Hu A, Mansour F, Nadeem I, Jiang Y, Athreya S. Image-guided energy ablation for palliation of painful bony metastases—a systematic review. J Vasc Intervent Radiol. 2024;35(9):1268-77.
Patel IJ, Pirasteh A, Passalacqua MA, Robbin MR, Hsu DP, Buethe J, et al. Palliative procedures for the interventional oncologist. American Journal of Roentgenology. 2013;201(4):726-35.
Revel-Mouroz P, Mokrane F, Collot S, Chabbert V, Rousseau H, Meyrignac O, et al. Hemostastic embolization in oncology. Diagn intervent imaging. 2015;96(7-8):807-21.
Referanslar
Abdelsalam ME, Ahrar K, Sheth RA, Shah KY, Yevich S, Gurusamy V, et al. Interventional oncology: A primer for clinicians on the role of ablation and embolization for solid tumors. CA: A Cancer Journal for Clinicians. 2026;76(1):e70051.
Young S, Golzarian J. Locoregional therapies in the treatment of 3-to 5-cm hepatocellular carcinoma: critical review of the literature. American Journal of Roentgenology. 2020;215(1):223-34.
Ahmed M, Brace CL, Lee Jr FT, Goldberg SN. Principles of and advances in percutaneous ablation. Radiology. 2011;258(2):351-69.
Chu KF, Dupuy DE. Thermal ablation of tumours: biological mechanisms and advances in therapy. Nature Reviews Cancer. 2014;14(3):199-208.
Gill AE, Hawkins CM. Introduction to interventional oncology: a COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer. 2023;70:e30234.
Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee Jr FT, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation—what should you use and why? Radiographics. 2014;34(5):1344-62.
Matthew Hawkins C, Towbin AJ, Roebuck DJ, Monroe EJ, Gill AE, Thakor AS, et al. Role of interventional radiology in managing pediatric liver tumors: part 2: percutaneous interventions. Pediatric Radiol. 2018;48(4):565-80.
Brace CL. Radiofrequency and microwave ablation of the liver, lung, kidney, and bone: what are the differences? Current problems in diagnostic radiology. 2009;38(3):135-43.
Kwak DH, Yu Q, Malavia M, Sellers E, Said A, Patel M, et al. Risk factors for abscess development following percutaneous microwave ablation therapy of hepatic tumors. CardioVasc Intervent Radiol. 2023;46(6):726-36.
Littrup PJ, Jallad B, Vorugu V, Littrup G, Currier B, George M, et al. Lethal isotherms of cryoablation in a phantom study: effects of heat load, probe size, and number. J Vasc Intervent Radiol. 2009;20(10):1343-51.
Mafeld S, Wong JJ, Kibriya N, Stenberg B, Manas D, Bassett P, et al. Percutaneous irreversible electroporation (IRE) of hepatic malignancy: a bi-institutional analysis of safety and outcomes. Cardiovasc intervent radiol. 2019;42(4):577-83.
Marelli L, Stigliano R, Triantos C, Senzolo M, Cholongitas E, Davies N, et al. Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc intervent radiol. 2007;30(1):6-25.
Rice SL, Berry-Tony S, Benjamin J, Kapur P, Alnablsi W, Lamus D, et al. The influence of preablation embolization particle size on the size of the microwave ablation zone in a porcine orthotopic renal tumor model. J Vasc Intervent Radiol. 2025;36(1):168-74.
Gunn AJ, Patel AR, Rais-Bahrami S. Role of angio-embolization for renal cell carcinoma. Current urology reports. 2018;19(10):76.
Wáng Y-XJ, De Baere T, Idée J-M, Ballet S. Transcatheter embolization therapy in liver cancer: an update of clinical evidences. Chinese Journal of Cancer Research. 2015;27(2):96.
Lee S, Ghosh A, Xiao N, Gordon AC, Heidarpour N, Funaki B, et al., editors. Embolic agents: particles. Seminars in Interventional Radiology; 2023: Thieme Medical Publishers, Inc.
Li D, Pua BB, Madoff DC, editors. Role of embolization in the treatment of renal masses. Seminars in interventional radiology; 2014: Thieme Medical Publishers.
Vogl TJ, Scheller A, Jakob U, Zangos S, Ahmed M, Nabil M. Transarterial chemoembolization in the treatment of hepatoblastoma in children. European radiol. 2006;16(6):1393-6.
He M, Cai J-B, Lai C, Mao J-Q, Xiong J-N, Guan Z-H, et al. Neoadjuvant transcatheter arterial chemoembolization and systemic chemotherapy for the treatment of undifferentiated embryonal sarcoma of the liver in children. World Journal of Clinical Cases. 2022;10(19):6437.
Lungren MP, Towbin AJ, Roebuck DJ, Monroe EJ, Gill AE, Thakor A, et al. Role of interventional radiology in managing pediatric liver tumors: part 1: endovascular interventions. Pediatric Radiol. 2018;48(4):555-64.
Mahnken AH, Spreafico C, Maleux G, Helmberger T, Jakobs TF. Standards of practice in transarterial radioembolization. Cardiovasc intervent radiol. 2013;36(3):613-22.
Rmilah AA, Qrareya MN, Fleming C, Alkurashi AK, Nyberg S, Leise M, et al. Association of cirrhosis and other patient and procedural characteristics with postembolization syndrome after bland hepatic artery embolization for hepatic malignancy. American Journal of Roentgenology. 2022;218(6):1030-9.
Lee HN, Hyun D. Complications related to transarterial treatment of hepatocellular carcinoma: a comprehensive review. Korean J Radiol. 2023;24(3):204-23.
Hsin I-F, Hsu C-Y, Huang H-C, Huang Y-H, Lin H-C, Lee R-C, et al. Liver failure after transarterial chemoembolization for patients with hepatocellular carcinoma and ascites: incidence, risk factors, and prognostic prediction. Journal of clinical gastroenterology. 2011;45(6):556-62.
Min YW, Kim J, Kim S, Sung YK, Lee JH, Gwak GY, et al. Risk factors and a predictive model for acute hepatic failure after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. Liver International. 2013;33(2):197-202.
Joskin J, de Baere T, Auperin A, Tselikas L, Guiu B, Farouil G, et al. Predisposing factors of liver necrosis after transcatheter arterial chemoembolization in liver metastases from neuroendocrine tumor. Cardiovasc Intervent Radiol. 2015;38(2):372-80.
Braat MN, van Erpecum KJ, Zonnenberg BA, van den Bosch MA, Lam MG. Radioembolization-induced liver disease: a systematic review. Eur J Gastroenterol Hepatol. 2017;29(2):144-52.
Spina JC, Hume I, Pelaez A, Peralta O, Quadrelli M, Garcia Monaco R. Expected and unexpected imaging findings after 90Y transarterial radioembolization for liver tumors. Radiographics. 2019;39(2):578-95.
Woo S, Chung JW, Hur S, Joo S-M, Kim H-C, Jae HJ, et al. Liver abscess after transarterial chemoembolization in patients with bilioenteric anastomosis: frequency and risk factors. American Journal of Roentgenology. 2013;200(6):1370-7.
Jia Z, Tu J, Cao C, Wang W, Zhou W, Ji J, et al. Liver abscess following transarterial chemoembolization for the treatment of hepatocellular carcinoma: A retrospective analysis of 23 cases. Journal of Cancer Research and Therapeutics. 2018;14:628-33.
Nakada S, Allard M-A, Lewin M, Awad S, Dahbi N, Nitta H, et al. Ischemic cholangiopathy following transcatheter arterial chemoembolization for recurrent hepatocellular carcinoma after hepatectomy: an underestimated and devastating complication. Journal of Gastrointestinal Surgery. 2020;24(11):2517-25.
Clark TW. Complications of hepatic chemoembolization. Semin intervent radiol. 2006;23(2):119-25.
Chen Y-F, Lin Z-Y, Chen L-T, Zhang Y, Du Z-Q. Cystic artery embolism after transarterial chemoembolization for hepatocellular carcinoma: A case report and review of the literature. World Journal of Gastrointestinal Oncology. 2025;17(3):99129.
Lin M-T, Kuo P-H. Pulmonary lipiodol embolism after transcatheter arterial chemoembolization for hepatocellular carcinoma. JRSM Short Reports. 2010;1(1):1-4.
Kim H-C, Kim GM. Radiation pneumonitis following yttrium-90 radioembolization: a Korean multicenter study. Frontiers in Oncology. 2023;13:977160.
Dhamija E, Deshmukh A, Meena P, Kumar M, Bhatnagar S, Thulkar S. Complementary role of intervention radiology in palliative care in oncology setting. Indian journal of palliative care. 2019;25(3):462.
Yao PF, Hu A, Mansour F, Nadeem I, Jiang Y, Athreya S. Image-guided energy ablation for palliation of painful bony metastases—a systematic review. J Vasc Intervent Radiol. 2024;35(9):1268-77.
Patel IJ, Pirasteh A, Passalacqua MA, Robbin MR, Hsu DP, Buethe J, et al. Palliative procedures for the interventional oncologist. American Journal of Roentgenology. 2013;201(4):726-35.
Revel-Mouroz P, Mokrane F, Collot S, Chabbert V, Rousseau H, Meyrignac O, et al. Hemostastic embolization in oncology. Diagn intervent imaging. 2015;96(7-8):807-21.
