Jan 17, 2019

Welcome to the ASCO Daily News podcast. I'm Lauren Davis. And joining me today is Dr. Alexander Kim, chief and residency program director of vascular and interventional radiology at Georgetown University Medical Center. He specializes in interventional oncology, and his practice is focused on locoregional cancer therapies. Dr. Kim, welcome to the podcast.

Thanks for the invitation, Lauren. I'm happy to be here.

Today we're talking about a somewhat new subspecialty in oncology-- interventional radiology. This can be used as both a diagnostic tool and a tool to administer therapies. How does that work?

So interventional radiology is a field where we use image guidance to perform minimally invasive procedures. So all of our procedures are performed under ultrasound, or CT, or sometimes MRI. And we're able to advance needles and catheters into places that, 15, 20 years ago, we weren't able to reach. And in terms of diagnosis, this has really revolutionized cancer management.

So for a patient with a nodule in in their abdomen, let's say, who previously may have had to go to the operating room for a biopsy and diagnosis, that patient now undergoes a same-day procedure in IR and just gets the CT biopsy performed. From that, it led to more and more therapies being developed, where we're now able to go in and treat various cancers in the kidney, and the liver, and lungs using the same techniques.

So how new is this technology? And how has it changed the way medicine has been practiced compared with, say, 10 years ago?
Interventional radiology is a subspecialty of radiology. And it actually initially was called special procedures. And that's been around since the '50s and '60s. Really, the dramatic change has really taken over in the last 10 to 15 years in terms of cancer care. And I like to think that we're one of the forefront specialties in the move towards minimally invasive procedures.

So again, whereas 10 years ago a patient may have had to go to the operating room for various procedures which required a patient to stay in the hospital for an extended period of time to recover after their surgery, with treatment and diagnostic modalities that we have, this really limits their hospital stay. And I think that's probably the biggest contribution that interventional radiology has made into the field of medicine-- is really minimizing the length of stay and, in turn, the quality of life of patients who may not have that much to live with their disease.

Tell me, what kind of program have you developed that your cancer center?

So we have a large interventional college of practice at Georgetown. We have a large NCI-designated cancer center, the Lombardi Cancer Center, where we get a lot of patient referrals from. We are also a large transplant center. And through that, we see a lot of HCC primary liver cancer patients. And one of the things that really benefits us is, really, the collaborative group that we have who work with us.

So our medical oncologist, and our surgical oncologist, and the radiation oncologist colleagues are really very pro-minimally invasive treatment. They're very local therapy friendly. So oftentimes, they're very open to different therapeutic suggestions that we bring up at our various multidisciplinary conferences. And I think that's really helped to grow our practice and helped it thrive.
What are some of the challenges in creating such a program?
You know, I think buy-in. Interventional radiology is a very under-recognized specialty, even within medicine. Part of our issue-- we have an identity issue. People outside of interventional radiology aren't really familiar with the things that we're capable of doing. So I think it requires a lot of effort amongst interventional radiologists who go to the multidisciplinary boards, and speak up, and say, hey, we could maybe approach this patient in this minimally invasive way. And after a while, that trust is built. So a lot of the groundwork-- having open-minded colleagues certainly helps.
Absolutely. And what are some of your measures of success?
In terms of the collaborative effort that we have, in terms of our overall patient management, the collaboration that we have, the open-mindedness to our input, I think, kind of defines our success within the hospital. And obviously, in terms of patient care, we want to make sure that we're at the forefront of research and producing good outcomes for the patients that we take care of.

And will these procedures that you do through interventional radiology-- do they increase progression-free survival or lead to possible cure rates?

Yeah, and I think a good number of our procedures do improve survival. A lot of the patient population that we see in integrative therapy is palliative. But there are more and more data that's coming out showing the potential survival improvement with our treatment. So recently, a study was published out of Europe. It's called the CLOCC trial, where they compared systemic chemotherapy alone versus chemotherapy plus ablation for patients with colorectal cancer with liver-only metastases.

There was a significant survival advantage in patients who underwent ablation plus systemic chemotherapy. And in fact, 35%-- actually, 36% of those patients were alive at 9 years, which is a pretty incredible finding. And there are other studies in other disease processes that are coming out that show that these minimally invasive therapies can potentially have curative effects. We need more data like that. But the data that's coming out, I think, are very promising.

That's wonderful. Again, today, my guest has been Dr. Alexander Kim. Thank you for being on our podcast today.

Thank you very much. That was really fun.

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