“Interventional oncology is a field of medicine where miracles happen for patients all the time.”
Sunday, October 13, 2019 (Miami, FL): The Symposium on Clinical Interventional Oncology (CIO) concluded three full days of education with a final session sharing dramatic interventional oncology cases. Nine faculty members presented in a session entitled “Outside Your IO Comfort Zone: Learning from Our Saves and Complications”, sharing both catastrophic complication and miraculous save cases.
Case presenters included Drs. Ziv J. Haskal, Alex Powell, Yolanda C. Bryce, Yasuaki Arai, Siddharth Padia, Raul N. Uppot, Isabel Newton, A. Nick Kurup, and Alessandro Lunardi.
Dr. Ziv Haskal shared a case of tumoral rupture after transarterial chemoembolization (TACE), leading to intraabdominal hemorrhage, additional embolization and decompensating liver function, and some perspectives on intratumoral extravasation with and without rupture and impact on patient outcomes. A second case described cardiac arrest during a case of drug-eluting embolic agent (DEE)-TACE with lipiodol and histopathologic explanation of the unusual cause.
Presenting on “Complication after Breast Cryoablation” in a 91-year-old female suffering dementia and with palpable left breast cancer, Dr. Yolanda Bryce discussed the impact on this case of an initial telemedicine exam versus the pre-procedure in-person exam. She said, “As we move forward with technology to make everything easier, and faster, and more convenient, let's not forget the foundations of good ‘old-fashioned’ medicine.” Dr. Bryce emphasized that “the physical exam of a patient is irreplaceable.”
Dr. Yasuaki Arai shared the “miraculous save” of a male in his 50s with poor renal function. In this case, bleeding occurred after a percutaneous liver biopsy. The blood vessel where the needle was inserted was embolized, but the bleeding continued. Ultimately, embolization of additional blood vessels, including the right hepatic artery, was also required. The lesson from this case? Dr. Arai noted, “The criminal is not always who (or what) you suspect. We should think the unthinkable (or expect the unexpected).”
Dr. Siddharth Padia discussed the case of a failed Y-90 radioembolization for a patient with liver cancer, due to portal venous shunting secondary to prior biopsy. However, a rescue strategy was created, which eventually achieved an optimal outcome, and the patient was successfully downstaged to liver transplant. He commented, “Occasionally, one must deviate from accepted guidelines and be come up with creative solutions in order to adequately target tumors for treatment.”
Dr. Raul Uppot shared the case of a patient with a 12 cm metastatic renal cell cancer tumor in his right pelvis. The patient was not a surgical candidate, and was having pain and difficulty walking as a result of this growing mass. For this “miraculous save”, the tumor was first embolized due to its vascularity. Then in the same angio suite, using cone beam computed tomography (CT), multiple cryoprobes were placed into the tumor to freeze and debulk the tumor. Over the course of the next four years, the tumor became devascularized and gradually shrank to be about 2 cm wide. The patient’s pain resolved, his walking improved his overall energy level, and outlook for his life improved. “The lesson from this case,” said Dr. Uppot, “is that minimally invasive tools including embolization and ablation can be used to debulk large tumors that would be too extensive for surgery.”
Dr. A. Nick Kurup shared a catastrophic case of air embolism complicating lung ablation. Excess positive airway pressure led to air escaping into the pleural cavity, subcutaneous tissues, and arterial system. Dr. Kurup noted, “We must watch our images closely and be aware of potential complications in order to react quickly and calmly for our patients.” As a great save, he presented a case of a large melanoma bone metastasis treated with displacement and monitoring to avoid nerve injury with long-term — now over 5-year — survival of the patient. “Interventional oncology is a field of medicine where miracles happen for patients all the time,” he said.
About the Symposium on Clinical Interventional Oncology (CIO)
Renowned for its originality, practicality, and focus on improving patient care, CIO, an HMP event, highlights the most viable and sought-after treatments in the rapidly expanding field of interventional oncology. CIO is led by course directors Ripal Gandhi, MD; Ziv Haskal, MD; Constantino Peña, MD; Daniel Sze, MD; and Alda Tam, MD. The program contains a mix of didactic lectures, case presentations and debates between experts, hands-on workshops, and pre-recorded cases woven together with audience interactivity through polling and question and answer sessions. For more information, visit theiomeeting.com.
HMP is the force behind Healthcare Made Practical – and is a multichannel leader in health care events and education, with a mission to improve patient care. The company produces accredited medical education events and clinically relevant, evidence-based content for the global health care community across a range of therapeutic areas. Its brands include Consultant360, the year-round, award-winning platform relied upon by primary care providers and other specialists; Psych Congress, the largest independent mental health meeting in the U.S.; EMS World Expo, North America’s largest EMT and paramedic event; and the Symposium on Advanced Wound Care (SAWC), the largest wound care meeting in the world. For more information, visit hmpglobal.com.