Where Intervention Meets Oncology
I know what you are thinking: “What does oncology have to do with Endovascular Today?” The topics within these pages usually pertain to vascular diseases and the many issues surrounding them. Even the name of the publication indicates a vascular orientation. So why this foray into cancer?
I think the answer lies in what Endovascular Today and its readers are really about. Regardless of our backgrounds, we are all fundamentally dedicated to the advancement of image-guided interventions. We share the belief that this is a critical path for procedures in the present and future. In this sense, just knowing what is happening in another part of the image-guided intervention world is worthwhile. We should all understand the full power and scope of what we and our colleagues can do. For example, keeping abreast of structural heart interventions is enlightening for all interventional specialists. In the world of Interventional Radiology, cancer interventions have become a large and important part of many practices and are now grouped under the moniker of Interventional Oncology. This concept has become so widely adopted that there are now books, journals, practices, and practitioners with this title, and our corporate partners are organizing their businesses accordingly.
This issue contains a range of great articles by acknowledged and rising experts. Venous disease is an obvious area of overlap between vascular and cancer specialists, so we have included a series of articles on a variety of venous topics, both including and not including oncology. Tom DeLoughery provides us with a concise, practical summary of the management of uncomplicated venous thromboembolism in the cancer patient. Kevin Seals and his colleagues address the management of acute venous emergencies in cancer patients, problems that all vascular specialists may face. Ryan Schenning and Jonathan Steinberger provide insights into the management of central venous occlusions in patients with malignancy. Rusty Hofmann discusses chronic venous occlusions and the unique demands of these recanalization procedures. A panel of experts (Erin Murphy, Marie-France Giroux, Deepak Sudheendra, Mark Garcia, and Matt Johnson) share their approaches to IVC filter retrieval, and Bob Ryu tells us about his goals with the Twitter hashtag, “#filterOUT.”
Image-guided interventions for primary and metastatic cancer in the liver are experiencing explosive growth, in part related to an increasing incidence and in part due to increased efficacy of these procedures. Matt Johnson and Jeffery Ramkaransingh provide an overview of treatment options for hepatoma, Bob Lewandowski and colleagues offer an update on liver metastatic neuroendocrine tumor therapies, and Dave Liu and colleagues address the complex area of hepatic metastases from colorectal cancer. Renal cell carcinoma is being diagnosed earlier and more frequently, and Thomas Atwell and colleagues report on the growing image-guided interventions for this disease. Raj Narayanan and Mehul Doshi share with us an impressive experience with image-guided interventions for pancreatic carcinoma that could shift treatment paradigms. Finally, we have an interview with Luis Angel on the progress to date in the FDA early feasibility trial of the Angel filter.
In a point/counterpoint discussion, two very articulate thoughtleaders, Andy Adam and Michael Soulen, debate whether or not Interventional Oncology is or should be an independent subspecialty. This is germane to all involved in image-guided intervention as the field grows and matures, and we develop natural concentrations of expertise. When should we be lumping, and when should we be splitting? As you will see, the answer is not always so clear.
I am extremely grateful that these busy people were able to contribute to this effort with articles that will provide you with an overview of the very leading edge of cancer interventions. I hope that all EVT readers will find something of value in this issue.
John A. Kaufman, MD, MS
Guest Chief Medical Editor