Interventional oncology is the image-guided treatment of tumors. Procedures applicable in children with cancer include percutaneous ablation and transarterial therapy and are almost always performed under general anesthesia. Patients are typically referred following discussion in a multidisciplinary team meeting or tumor board.
Percutaneous treatment may be performed with curative or palliative intent and without compromising the effectiveness of other modalities such as chemotherapy or radiation therapy. Several different forms of percutaneous treatment are available, including radiofrequency ablation, microwave ablation, and cryoablation, but the evidence base for each is still quite limited.
Intraarterial delivery of anticancer treatment is attractive, in principle, because of the potential to increase local effectiveness with reduced systemic toxicity. Various techniques are used in children, most commonly for the treatment of retinoblastoma and liver tumors.
This is a preview of subscription content, log in to check access.
Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT Jr, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why? Radiographics. 2014;34(5):1344–62.CrossRefGoogle Scholar
Gomez FM, Patel PA, Stuart S, Roebuck DJ. Systematic review of ablation techniques for the treatment of malignant or aggressive benign lesions in children. Pediatr Radiol. 2014;44(10):1281–9.CrossRefGoogle Scholar
Hoffer FA, Daw NC, Xiong X, Anghelescu D, Krasin M, Yan X, et al. A phase 1/pilot study of radiofrequency ablation for the treatment of recurrent pediatric solid tumors. Cancer. 2009;115(6):1328–37.CrossRefGoogle Scholar
Liu B, Zhou L, Huang G, Zhong Z, Jiang C, Shan Q, et al. First experience of ultrasound-guided percutaneous ablation for recurrent hepatoblastoma after liver resection in children. Sci Rep. 2015;5:16805.CrossRefGoogle Scholar
Cazzato RL, Garnon J, Ramamurthy N, Koch G, Tsoumakidou G, Caudrelier J, et al. Percutaneous image-guided cryoablation: current applications and results in the oncologic field. Med Oncol. 2016;33(12):140.CrossRefGoogle Scholar
Schmitz JJ, Schmit GD, Atwell TD, Callstrom MR, Kurup AN, Weisbrod AJ, et al. Percutaneous cryoablation of extraabdominal desmoid tumors: a 10-year experience. AJR Am J Roentgenol. 2016;207(1):190–5.CrossRefGoogle Scholar
Cornelis FH, Marin F, Labreze C, Pinsolle V, Le Bras Y, Midy D, et al. Percutaneous cryoablation of symptomatic venous malformations as a second-line therapeutic option: a five-year single institution experience. Eur Radiol. 2017;27(12):5015–23.CrossRefGoogle Scholar
Shaikh R, Alomari AI, Kerr CL, Miller P, Spencer SA. Cryoablation in fibro-adipose vascular anomaly (FAVA): a minimally invasive treatment option. Pediatr Radiol. 2016;46(8):1179–86.CrossRefGoogle Scholar
Whitmore MJ, Hawkins CM, Prologo JD, Marshall KW, Fabregas JA, Yim DB, et al. Cryoablation of osteoid osteoma in the pediatric and adolescent population. J Vasc Interv Radiol. 2016;27(2):232–7. quiz 238.CrossRefGoogle Scholar
Lessard AM, Gilchrist J, Schaefer L, Dupuy DE. Palliation of recurrent Ewing sarcoma of the pelvis with cryoablation and somatosensory-evoked potentials. J Pediatr Hematol Oncol. 2009;31(1):18–21.CrossRefGoogle Scholar
Lyu T, Wang X, Su Z, Shangguan J, Sun C, Figini M, et al. Irreversible electroporation in primary and metastatic hepatic malignancies: a review. Medicine (Baltimore). 2017;96(17):e6386.CrossRefGoogle Scholar
Hara F, Kishikawa T, Tomishige H, Nishikawa O, Nishida Y, Kongo M. A child with adrenocortical carcinoma who underwent percutaneous ethanol injection therapy for liver metastasis. J Pediatr Surg. 2003;38(8):1237–40.CrossRefGoogle Scholar
Abramson DH, Dunkel IJ, Brodie SE, Kim JW, Gobin YP. A phase I/II study of direct intraarterial (ophthalmic artery) chemotherapy with melphalan for intraocular retinoblastoma initial results. Ophthalmology. 2008;115(8):1398–404. 1404.e1391.CrossRefGoogle Scholar
Bertelli E, Leonini S, Galimberti D, Moretti S, Tinturini R, Hadjistilianou T, et al. Hemodynamic and anatomic variations require an adaptable approach during intra-arterial chemotherapy for intraocular retinoblastoma: alternative routes, strategies, and follow-up. AJNR Am J Neuroradiol. 2016;37(7):1289–95.CrossRefGoogle Scholar
Phillips TJ, McGuirk SP, Chahal HK, Kingston J, Robertson F, Brew S, et al. Autonomic cardio-respiratory reflex reactions and superselective ophthalmic arterial chemotherapy for retinoblastoma. Paediatr Anaesth. 2013;23(10):940–5.CrossRefGoogle Scholar
Shields CL, Alset AE, Say EA, Caywood E, Jabbour P, Shields JA. Retinoblastoma control with primary intra-arterial chemotherapy: outcomes before and during the intravitreal chemotherapy era. J Pediatr Ophthalmol Strabismus. 2016;53(5):275–84.CrossRefGoogle Scholar
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. Pediatr Radiol. 2018;48(4):555–64.CrossRefGoogle Scholar
Roebuck DJ. Alternative approaches for treatment. In: Zimmermann A, Perilongo G, Malogolowkin M, von Schweinitz D, editors. Pediatric liver tumors. Berlin: Springer; 2011. p. 177–88.CrossRefGoogle Scholar
Hawkins CM, Kukreja K, Geller JI, Schatzman C, Ristagno R. Radioembolisation for treatment of pediatric hepatocellular carcinoma. Pediatr Radiol. 2013;43(7):876–81.CrossRefGoogle Scholar
Ghanouni P, Dobrotwir A, Bazzocchi A, Bucknor M, Bitton R, Rosenberg J, et al. Magnetic resonance-guided focused ultrasound treatment of extra-abdominal desmoid tumors: a retrospective multicenter study. Eur Radiol. 2017;27(2):732–40.CrossRefGoogle Scholar
Shim J, Staruch RM, Koral K, Xie XJ, Chopra R, Laetsch TW. Pediatric sarcomas are targetable by MR-guided high intensity focused ultrasound (MR-HIFU): anatomical distribution and radiological characteristics. Pediatr Blood Cancer. 2016;63(10):1753–60.CrossRefGoogle Scholar
Wang S, Yang C, Zhang J, Kong XR, Zhu H, Wu F, et al. First experience of high-intensity focused ultrasound combined with transcatheter arterial embolization as local control for hepatoblastoma. Hepatology. 2014;59(1):170–7.CrossRefGoogle Scholar
Streby KA, Geller JI, Currier MA, Warren PS, Racadio JM, Towbin AJ, et al. Intratumoral injection of HSV1716, an oncolytic herpes virus, is safe and shows evidence of immune response and viral replication in young cancer patients. Clin Cancer Res. 2017;23(14):3566–74.CrossRefGoogle Scholar