Cross-sectional study of the provision of interventional oncology services in the UK

A survey of liver ablation amongst UK interventional radiologists

AIM

To characterise training for, and conduct of, image-guided liver tumour ablation amongst UK interventional radiologists.

MATERIALS AND METHODS

A web-based survey of British Society of Interventional Radiology members was carried out between 31 August to 1 October 2022. Twenty-eight questions were designed, covering four domains: (1) respondent background, (2) training, (3) current practice, and (4) operator technique.

RESULTS

One hundred and six responses were received, with an 87% completion rate and an approximate response rate of 13% of society members. All UK regions were represented, with the majority from London (22/105, 21%). Seventy-two out of 98 (73%) were either extremely or very interested in learning about liver ablation during training, although levels of exposure varied widely, and 37/103 (36%) had no exposure. Performed numbers of cases also varied widely, between 1-10 cases and >100 cases per operator annually. All (53/53) used microwave energy, and most routinely used general anaesthesia (47/53, 89%). Most 33/53 (62%) did not have stereotactic navigation system, and 25/51(49%) always, 18/51 (35%) never, and 8/51(16%) sometimes gave contrast medium (mean 40, SD 32%) after procedures. Fusion software to judge ablation completeness was never used by 86% (43/55), sometimes used by 9% (5/55), and always used by 13% (7/55) of respondents.

CONCLUSION

Although there are high levels of interest in image-guided liver ablation amongst UK interventional radiologists, training arrangements, operator experience, and procedural technique vary widely. As image-guided liver ablation evolves, there is a growing need to standardise training and techniques, and develop the evidence base to ensure high-quality oncological outcomes.

A Multi-centre, Single Arm, Non-randomized, Prospective European Trial to Evaluate the Safety and Efficacy of the HistoSonics System in the Treatment of Primary and Metastatic Liver Cancers (#HOPE4LIVER)

PURPOSE

Image-guided thermal ablation are established treatment options for non-surgical patients with primary and metastatic liver cancers. However, there are limitations with nonuniformity of cancer tissue destruction, heat sink effect and the risk of thermal ablative injury. The current non-thermal ablative techniques have high risk of local recurrence and are not widely adopted. Histotripsy is a treatment technology that destroys targeted tissue under ultrasound visualization via mechanical destruction through the precise application of acoustic cavitation and can offer the potential of non-invasive, non-thermal and non-ionizing radiation cancer treatment. The aim of this multi-centre non-randomized phase I/II trial is to assess the initial safety and efficacy of the prototype investigational 'System' in the treatment of primary and metastatic liver cancers.

METHODS/DESIGN

All non-surgical patients with primary/metastatic liver cancers having had previous liver directed therapy, radiation therapy or image-guided ablation may be offered image-guided Histotripsy as per trial protocol. The co-primary endpoints are technical success and procedural safety. Technical success is determined, at ≤ 36 h post procedure, by evaluating the histotripsy treatment size and coverage. The procedural safety is defined by procedure related major complications, defined as Common Terminology Criteria for Adverse Events (CTCAE version 5) grade 3 or higher toxicities, up to 30 days post procedure. This phase I/II trial has intended to recruit up to 45 patients to show safety and efficacy of image-guided histotripsy in liver cancers.

TRAIL REGISTRATION

Clinicaltrials.gov identifier-NCT04573881; NIHR CRN CPMS-ID 47572.

Developing a Roadmap for Interventional Oncology

Interventional oncology uses image-guided procedures to enhance cancer care. Today, this specialty plays an increasingly critical role in cancer diagnosis (e.g., biopsy), cancer therapy (e.g., ablation or embolization), and cancer symptom palliation (e.g., nephrostomies or biliary drainages). Although the number of procedures and technical capabilities has improved over the last few years, challenges remain. In this article we discuss the need to advance existing procedures, develop new ones, and focus on several operational aspects that will dictate future interventional techniques to enhance cancer care, particularly by accelerating drug development and improving patient outcomes.

IMPLICATIONS FOR PRACTICE

Interventional oncology is vital for cancer diagnosis, therapy, and symptom palliation. This report focuses on current interventional procedures and techniques with a look toward future improvements that will improve cancer care and patient outcomes.