Advances in Minimally Invasive Tumor Treatment

Minimally invasive medicine and biomedicine have become two major trends and hot spots in the development of medicine in the 21st century, and are important components of comprehensive tumor treatment. Minimally invasive tumor treatment represents patient-oriented rationalization and scientific treatment, which is a concrete embodiment of “bio-social-psychological” medical model and reduces the “trauma” of patients from two levels: physiological and psychological. It is a concrete embodiment of the “bio-social-psychological” medical model, which reduces the “trauma” of patients at both physical and mental levels. What must be emphasized and clarified is: modern minimally invasive tumor treatment is different from the concept of minimally invasive proposed by other disciplines, it is based on medical imaging, with imaging equipment and technology as the orientation and guidance, integrating advanced medical imaging technology, drug therapy, biological and genetic technology and high-tech medical technology (such as radiofrequency ablation, particle implantation, laser, ultrasound focus, endoscopy, lumpectomy, photodynamic, etc.) into one, which has the advantages of It is a modern tumor treatment method with the advantages of precise location, precise treatment, less trauma, less pain, and exact curative effect. Minimally invasive tumor treatment in the 21st century has developed from traditional interventional radiology to MRI, CT, ultrasound, DSA, endoscopy and lumpectomy, and includes drug therapy (such as thrombolysis, chemoembolization), ablation therapy, drug and biological therapy. Minimally invasive treatment methods such as drug therapy (e.g. thrombolysis, chemoembolization), ablation therapy, drug and biological gene therapy are covered. At present, minimally invasive tumor treatment is broadly divided into two categories: vascular minimally invasive treatment and non-vascular minimally invasive treatment. The former includes intravascular drugs, perfusion, embolization, vasodilatation and angioplasty, endoprosthesis, and vena cava filter implantation. The latter includes ablation therapy (physical ablation and chemical ablation), inter-tissue implantation of radioactive and drug particles, lumpectomy, endoscopic therapy, lumpectomy and endoprosthesis, etc. In recent years, the emergence of timely monitoring devices and technologies as well as the improvement of precise judgment and analysis of microscopic lesions have further improved the targeting and efficacy of tumor treatment, and have provided better support and evaluation of whether tumors can be treated radically in evidence-based medicine. It also provides better support and evaluation of whether tumors can be treated radically in evidence-based medicine. Modern medical imaging is the “eye” for precise guidance of minimally invasive tumor treatment. The advanced diagnostic and localization technologies make minimally invasive tumor treatment more and more precise and accurate. The one-step precise positioning and one-step accurate treatment reflect the new characteristics of minimally invasive tumor treatment in the 21st century, which is the important point that minimally invasive tumor treatment is better than the traditional treatment mode. Sequential combination of multiple minimally invasive treatment methods Sequential combination mode is a minimally invasive treatment mode based on the biological behavior of tumor, clinical, imaging and laboratory examination, and the principle of maximizing the destruction of tumor and maximizing the protection of human physiological function and immune function, combining several minimally invasive treatment methods in a scientific order to achieve complementary advantages and improve the therapeutic effect. The sequential combined treatment mode of minimally invasive tumor treatment is especially the organic combination of vascular minimally invasive treatment and non-vascular minimally invasive treatment, which destroys and inactivates tumor tissues through different mechanisms, and is a dual treatment of overall (regional) treatment at the level of the organ where the tumor is located and local intensive treatment at the level of the lesion. Taking primary liver cancer as an example, the sequential combination of both hepatic artery embolization chemotherapy (TACE) and ablation therapy, that is, on the basis of TACE, after the imaging judgment and analysis of residual active tumor components, ablation therapy is performed on residual active lesions in the liver, which can cause complete necrosis of tumor tissues (including residual lesions, subfoci and micro lesions) in the lesion area and further improve the effect of treatment. III. Minimally invasive treatment and multidisciplinary comprehensive tumor treatment Multidisciplinary comprehensive tumor treatment refers to the planned and rational application of various effective existing multidisciplinary treatments according to the patient’s physical and mental condition, specific location, pathological type, invasion scope and development tendency of tumor, combined with the changes of cellular molecular biology, so as to achieve the best treatment effect with the most appropriate economic cost, and at the same time to improve the patient’s The quality of life of patients is also improved. The important theoretical basis of minimally invasive therapy is to inactivate the residual tumor foci including tumor stem cells through minimally invasive therapy after tumor load reduction, to further inactivate the tumor foci from the source and effectively prevent tumor recurrence and metastasis. (i) New paradigm of tumor treatment: image-guided minimally invasive therapy combined with bioimmunotherapy and molecular targeted therapy If minimally invasive therapy eliminates lesions that can be observed by macroscopic imaging, bioimmunotherapy mainly eliminates subimaging tumor lesions or micro lesions that cannot be shown by imaging. (II) Combined surgical treatment Minimally invasive treatment combined with surgical operation can help to reduce the tumor load preoperatively and can effectively solve the problems of postoperative residual, recurrence or reoccurrence, which are reflected in the following three aspects: 1) cases with large tumors that are not suitable for surgical resection in the first stage: the unresectable tumor lesions can be made to be reduced and limited through local embolization chemotherapy to achieve the lesions that can be surgically resected. The condition of surgical resection can be achieved. For example, “stage II resection of hepatocellular carcinoma”, etc. 2) cases with poor physical tolerance for surgery or those who refuse surgery. 3) cases with postoperative residual, recurrence or reoccurrence. (3) Combination chemotherapy 1) Minimally invasive treatment for chemotherapy-sensitive solid tumors: After systemic chemotherapy reduces the tumor load, the residual foci including tumor stem cells are directly inactivated by minimally invasive treatment, which can further inactivate the tumor foci from the source and effectively prevent tumor recurrence and metastasis. 2) Minimally invasive treatment for chemotherapy-insensitive solid tumors: alternating systemic intravenous chemotherapy and minimally invasive treatment for direct inactivation of local tumors can mutually improve the therapeutic effect. 3) Transcatheter arterial infusion chemotherapy: selective arterial cannulation injects chemotherapeutic drugs into tumor tissues through tumor blood supply arteries to achieve local infusion chemotherapy, which can greatly improve local drug concentration and reduce blood concentration, thus improving efficacy and reducing adverse effects. It should be emphasized and clarified that: before the transcatheter arterial infusion chemotherapy, the pathological nature of the tumor should be determined, and concentration-dependent chemotherapeutic drugs sensitive to the tumor or relatively sensitive to the tumor should be selected, and the dosage should not exceed the dosage of one course of systemic chemotherapy. 4) Transcatheter arterial chemoembolization: The chemotherapeutic drugs and embolic agents are injected into the tumor tissue through the tumor blood supply artery through the catheter, and the chemotherapeutic drugs stay in the tumor at a higher concentration and for a longer period of time, killing the tumor cells while embolizing the tumor blood vessels can promote the necrosis of the tumor cells, and can reduce the concentration of the drugs in the body circulation and reduce the toxic effects of systemic chemotherapy to achieve better therapeutic effects. (4) Combined radiotherapy Minimally invasive treatment combined with radiotherapy can not only reduce the chance of further development and dissemination of tumor, but also supplement the shortage of simple radiotherapy, and make certain large tumor lesions shrink and limited by ablation therapy and local embolization chemotherapy, so as to reduce the clinical target area and planned target area of radiotherapy, increase the maximum radiation tolerance dose, and improve the success rate of radiotherapy. Minimally invasive treatment for radical tumors: local and regional minimally invasive interventions combined with systemic multi-level treatment With the continuous development of minimally invasive tumor treatment disciplines and under the guidance of evidence-based medicine, more and more advanced minimally invasive treatments are being applied through the sequential combination of each other and the new mode of minimally invasive treatment combined with biological treatment to achieve the purpose of radical treatment for certain tumors and achieve curative effects comparable to those of radical treatment for some tumors. The efficacy of these treatments is comparable to the radical treatment of some tumors. For example, “TACE sequential combined with ablation therapy + biogene therapy” for primary liver cancer and “minimally invasive interventional therapy + regional arterial perfusion therapy + biogene therapy and systemic therapy” for early stage breast cancer. Like other treatments for tumors, radical minimally invasive treatment requires certain indications, such as early stage tumors. V. Humanized and rationalized treatment In the history of human conquering cancer, traditional surgery, chemotherapy and radiotherapy have undoubtedly played and will still play an important and active therapeutic and exploratory role. However, frankly speaking, “radical surgical resection”, “radical chemotherapy” and “radical radiotherapy” are an incomplete and limited understanding in the process of research, exploration and understanding of tumor biological behavior. Therefore, to some extent, it is an over-optimistic implication and misleading to patients in choosing treatment methods, and it is at the cost of great destruction or even dissipation of the physiological function or immune function of the body. Although it reflects a kind wish of anti-cancer physicians and their determination and confidence in treating tumors, it is in some sense contrary to the concept of humanization and rationalization, and to some extent restricts the progress of tumor treatment. For example, breast cancer and liver cancer. Then minimally invasive interventional therapy combined with systemic systemic therapy, especially biological therapy, truly reflects a humanized and rationalized treatment. Minimally invasive lymph node dissection refers to the advanced minimally invasive treatment techniques to inactivate lymph nodes (including sentinel lymph nodes) and distant metastatic lymph nodes under the guidance of modern medical imaging equipment, such as I125 radioactive particle inter-tissue implantation, ultrasonic focus therapy, etc. Seven, minimally invasive tumor treatment leads the multi-level division of tumor TNM staging system M staging, which expands a whole new field for personalized treatment of stage IV patients and the application and efficacy evaluation of new treatment means, especially interventional minimally invasive techniques. To sum up, although the traditional three major treatment means surgery, chemotherapy and radiotherapy play a certain positive therapeutic role in the treatment of certain tumors, however, in many cases, they are limited by the poor general condition of patients, the insensitivity of tumor tissues to chemotherapy drugs or the maximum dose of radiation therapy. With the continuous development of high and new technology and the continuous updating of social medical concept, the treatment methods with great trauma and damage to human immune function will gradually develop in the direction of minimally invasive treatment and biogene therapy. The new model of minimally invasive therapy combined with biological therapy and molecular targeted therapy will become an important part of tumor treatment in the new century.