PALLIATIVE CARE 1: INTERVENTIONAL RADIOLOGY IN PALLIATIVE CARE FOR CANCER

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Abstract

Background

Palliative care is recently recognized as an important aspect of cancer management. Interventional radiology (IR) is an effective treatment option in palliative care for cancer patients. However, IR is not well-known to oncologists and there are few evidences based on prospective studies of IR.

Learning objects

(i) to review the procedures of IR in palliative care; (ii) to review the results of IR in palliative care; (iii) to discuss the problems of IR as palliative care in clinical practice.

Procedures

Attractive procedures of IR in palliative care would be introduced as follows: (i) drainage (including shunt) of accumulated fluids; (ii) metallic stent placement for obstruction; (iii) vertebroplasty or radiofrequency ablation (RFA) for cancer pain relief; (iv) repair of leakage or bleeding.

Results

There were some retrospective reports, but few prospective studies in IR as palliative care. Japan Interventional Radiology in Oncology Study Group (JIVROSG) was organized in 2002 and has been conducted several prospective studies. In particular, phase I/II study of percutaneous vertebroplasty (PVP) as a palliative care (JIVROSG-0202) demonstrated the efficacy of PVP to relive pain due to malignant vertebral compression fractures (Ann Oncol 2009) and PVP was approved for this indication in December 2009.

Issues and solutions for IR in clinical practice

First, IR in palliative care has been still not well known to medical staff and cancer patients. So, we have joined the meeting of Japanese Society of Palliative Medicine and other various meetings recently to present the important role of IR in palliative care. Secondly, there are not enough interventional radiologists who can perform these IR procedures. Therefore, patients have to be transferred to special hospitals as our hospital for IR. Indication of IR and duration of hospitalization have been informed to neighboring hospitals. Also, educational program for IR procedure should be established. Finally, since IR is an important palliative treatment as well as medical therapy and psychological care, it is better to be integrated in multidisciplinary approach to cancer patients.

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