Kesho Conference 2014

1. Opportunities in interventional oncology
 Dr. Henry Wanga
 Consultant Interventional Radiologist
 Zenith Medical Centre
 General Accident Insurance House
 Ralph Bunche Road, Upper Hill Nairobi

2. KESHO
 Kenya Society of Hematology and Oncology Third
Annual Scientific Conference
 Panafric Hotel, Nairobi Kenya
 28th November 2014

3. Angiography, Biopsy and Drainage
 Interventional Radiology(IR) is a clinical subspecialty with a rich history of
innovations
 We approach our work through clinical problem solving with our referring
specialists
 Many IR practices have shifted from peripheral vascular interventions to
interventional oncology
 Multimodal imaging methods have superseded the traditional arteriography
 Embolic agents can be permanent, temporary, or combined with an agent
such as chemotherapy
 Pelvic malignancies may cause lower extremity deep vein thrombosis.
Treatment is by placing permanent or temporary inferior vena cava filters
 Complications in IR practice are uncommon

4. Oncologic applications
 VASULAR
 A. diagnostic information(e.g. vascular invasion, biopsy)
 Diagnosis and treatment of associated conditions,(DVT,
central venous access, hemorrhage)
 Local delivery of chemotherapy
 Embolotherapy
 Brachytherapy delivery
 2. NON-VASCULAR
 Diagnostic information(PTHC, biopsy)
 Treatment of associated conditions (e.g. GI/GU/ biliary
obstruction)
 Local tumor ablation(RF/ thermal, ethanol,acetic
acid,cisplatin -epigel)

5. Continued Oncologic applications
 Brachytherapy delivery
 3. Disease control vs. palliation
 4. Connections with Basic Science(small animal, cellular
culture, etc) and Clinical Research(clinical trials)

6. Interventional Radiology locally practices
 Image guided tumor ablation with ethanol
 Transcatheter arterial embolization(TAE)
 Transcatheter arterial chemoembolization(TACE)
 Combined TAE and TACE

7. Agents used in embolization treatment
of malignancies
 Gelfoam sponge temporary –haemostasis
 Poly vinyl alcohol particles (PVA) - permanent occlusion.
Comes in sizes 100, 200, 300, 500,700,or 1000 microns
 Drug eluting beads (DEB)
 Coils

8. Chemo infusion Agents
 Cisplatin
 Doxorubicin
 Mitomycin c
 Paclitaxel
 And many others

9. Hepatocellular carcinoma: Solitary
tumor <3 cm
Treatment/Procedure Rating Comments
Systemic chemotherapy 3
Resection 8
Transplantation 9
Chemical ablation 6
Thermal ablation 8
Tran arterial embolization (TAE) 5
Tran arterial chemoembolization (TACE) 5
Selective internal radiation therapy (SIRT) 5
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate

10. Hepatocellular carcinoma: Solitary
tumor 5 cm
Treatment/Procedure Rating Comments
Systemic chemotherapy 3
Resection 8
Transplantation 9
The tumor is too large for chemical ablation. May
Chemical ablation 3 use it instead of or in addition to thermal ablation
depending on tumor location.
Thermal ablation 5
Tran arterial embolization (TAE) 6
Tran arterial chemoembolization (TACE) 7
Selective internal radiation therapy (SIRT) 7
Especially applicable in portal vein thrombosis or
extensive bilobar disease.
Transarterial chemoembolization (TACE)
7
combined with thermal ablation
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate

11. Metastatic liver disease: Multifocal colorectal carcinoma (liver
dominant or isolated), 5 cm
tumors.
Treatment/Procedure Rating Comments
Systemic chemotherapy 9
Resection 7
Transplantation 1
Chemical ablation 1
Thermal ablation 2
Hepatic arterial chemotherapy infusion 5
Transarterial embolization (TAE) 5
Transarterial chemoembolization (TACE) 5
Selective internal radiation therapy (SIRT) 5
Transarterial chemoembolization (TACE)
5
Depends on tumor burden.
combined with thermal ablation
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate

13. Radionuclide Bone Scan
 Normal bone scan

14. Metastatic breast cancer
 Radionuclide 99Tc studies

15.  IGS for Interventional Oncology
 Innova* Image Guided Systems (IGS) for Interventional
Oncology provide excellent image quality with
exceptional dose efficiency. Get excellent organ coverage
for tumor embolization, ablation techniques, and 3D
guidance. Our flagship Innova IGS 540 with the Innova
CT option enhances soft tissue visualization for imaging
of high- and low-density tissues.

16. IGS for Interventional Oncology

17. Liver surgical anatomy
 Anterior surface showing eight divisions

18. Hepatic veins and portal veins
 Segmental Porto-venous circulation

19. The Mater hospital Cat lab
 Ceiling suspended C-ARM Angiography unit

20. Left hepatic lobe hemangioma
 Achieved complete hemangioma embolisation end point

21. Hepatic hemangioma
 Symptoms: nausea, right hypochondriac pains and
anorexia.
 All disappeared after treatment with poly vinyl alcohol
particles

22. TACE and Chemoembolization
 After a second course

23. HEPATOMA

24. Embolisation with coils, following
polyvinyl alcohol particles

25. Discussion
 Hepatocellulacr carcinoma is the most common primary
malignancy of the liver
 Predisposed in patients with chronic liver diseases such as
cirrhosis, hemochromatosis, alcoholism and glycogen
storage disease
 Hepatitis Chas been attributed to lead to increase HCC in
the United States. Age at presentation is in the sixth and
seventh decades
 In Kenya the incidence is in the fourth and fifth decades

26. Major patterns of growth of HCC
 Solitary mass
 Multifocal masses
 Diffusely infiltrating mass

27. Hepatic metastasis
 This is the most common malignancy of the liver arising
from the colon, stomach, pancreas, breast, and lung
neoplasm
 In children, metastases are commonly from neuroblastoma
and Wilm’s tumor
 Prognosis depends on the primary tumor site.

28. Metastatic cholangiocarcinoma
 Axial CT scan slice

29. Biliary drainage
 Ward nurses
PAA

30. Let us go on a hunting mission
 Masai Mara

31. Acknowledgements
 Aga Khan University hospital, Karachi, Pakistan
 Lifestyle, hospital, Pretoria
 The Nairobi Hospital
 Many colleagues; Dr. Abwao, Dr. Njuguna, Dr.
Ndagwatha, Dr. Githaiga, Dr. Otele, Dr. Nyongesa, Dr.
Ochieng( now studying in South Africa)
 Radiology colleagues especially the late Dr. Sara Goretti
Tata
 Colleagues at Mulago Hospital, Makerere University,
Kampala Uganda
 Indeed all of YOU