An exciting relatively new approach to the treatment of neuroendocrine tumors is “interventional radiology.” As the name suggests, this is the medical field in which radiologists with advanced training deliver treatments that are guided by imaging (radiology). This approach can be used to deliver a variety of therapies, including:
- Chemoembolization is a method of delivering high doses of chemotherapy directly to neuroendocrine tumors in the liver. Good results have been obtained using chemoembolization on patients who are not candidates for standard therapy. A small catheter from the blood vessel in the patient’s groin is placed into the artery that supplies blood to the liver. Chemotherapeutic drugs can then be delivered through the catheter along with a blood vessel occluding agent right to the blood vessels supplying the tumor. As a result, highly concentrated chemotherapy is delivered and, at the same time, the blood vessels supplying the tumor are partially blocked with the occluding agent starving the tumor of it's blood supply. This "double-punch" can slow or stop tumor growth, and in some cases can even result in significant shrinkage of the tumor.
- Radioembolization is a method similar to chemoembolization, only radioactive (Yttrium-90) beads are delivered instead of chemotherapy. These radioactive beads deliver radiation directly to the tumor, minimizing systemic side effects while maximizing local delivery to the tumor.
- Radio Frequency Ablation (RFA) is another technique that can be used to treat tumors, particularly tumors that have metastasized (spread) to the liver. Radio frequency ablation, as the name suggests, uses radio frequency waves to destroy tumors. Basically, under radiology guidance, a long a needle-like probe is inserted through the skin and the tip placed inside the tumor. The operator then activates the device passing radio frequency waves through the probe into the tumor. These waves greatly increase the temperature within neuroendocrine tumor and the increased heat kills the tumor. This approach can also be used intraoperatively, in which case the probe is place directly by the surgeon.
As you can see there are a host of new options available for the treatment of neuroendocrine tumors. Determining which of the many options available is right for a particularly patient requires an experienced multi-disciplinary team such as the team assembled at Johns Hopkins.