Interventional treatment of malignant tumors without surgery

The harm of malignant tumor is well known, according to the nationwide survey on the causes of death in China in 1990s, malignant tumor accounts for 17.9% of the causes of death. In recent years, the level of diagnosis and treatment of malignant tumors has been greatly improved. Based on the conventional treatment methods such as surgery, chemotherapy and radiotherapy, many effective new treatment methods have emerged, which promote the development of tumor therapeutics, among which interventional treatment technology has become one of the important components of clinical therapeutics of malignant tumors. Interventional therapeutics is an emerging borderline discipline combining medical imaging and clinical therapeutics developed in the 1970s, which has the significant therapeutic features of minimally invasive and locally efficient, and some scholars call it one of the three major diagnostic techniques alongside with internal medicine and surgery. Interventional therapy has become one of the important means of clinical treatment in modern hospitals for many diseases that were considered incurable or difficult to treat clinically, especially in the treatment of tumors. I. Classification of malignant tumor interventional therapy (a) Vascular interventional therapy. Vascular interventional therapy is to infuse anti-cancer drugs and vascular blocking substances into the tumor blood supply arteries, so that the drugs can be directly applied to the local lesions. Vascular interventional therapy includes tumor artery chemotherapy, embolization and chemoembolization. The efficacy of chemotherapy for malignant tumors depends on many factors, one of which is the local concentration and duration of action of the drug in the tumor. The higher the concentration of most chemotherapeutic drugs and the longer the contact time between drugs and cancer cells, the greater the effect of killing cancer cells and the better the efficacy. Interventional therapy provides the main method for arterial sequential chemotherapy of malignant tumors. 1.Selective arterial infusion chemotherapy. A very thin special catheter is inserted into the blood supply artery of the tumor under the guidance of imaging equipment to inject chemotherapeutic drugs. For example, in the interventional treatment of liver cancer, doctors can combine several most effective anti-cancer drugs together and use the interventional method to find the trophoblastic artery of liver cancer by imaging from the abdominal aorta, then through the fine catheter, the anti-cancer drug is directly instilled into the tumor tissue, and the tumor will be necrosed soon. This treatment method is called “arterial perfusion interventional therapy” for hepatocellular carcinoma, just like weeding with highly concentrated pesticide, then the grass will surely die. By applying this method, the anti-cancer drug will enter the tumor in seconds through the catheter, and the drug dosage is only 1/2 to 1/5 of the intravenous systemic drug dosage, which can effectively reduce the toxic side effects of the drug and improve the treatment effect. 2.Selective arterial embolization. It is to embolize the blood supplying artery of tumor, that is, to embolize the blood supplying artery of tumor temporarily or permanently by using vascular embolic agents, such as gelatin sponge, stainless steel ring, autologous blood clot, etc., to block the nutrition supply of tumor, so as to reduce the volume of tumor and facilitate surgical resection and reduce intraoperative bleeding. The combination of arterial perfusion therapy for patients with inoperable advanced malignant tumors can play a better role in palliative treatment, relieve patients’ pain and bleeding symptoms, and prolong survival time. 3. Chemoembolization. In the past ten years or so, many scholars have conducted research on new drug dosage forms, i.e. drug carriers, to find the feeding arteries of tumors through catheter technology, and inject anti-cancer drugs and embolic agents directly into tumor arteries in organic combination. Both embolize the terminal branches of tumor tissues and block the blood supply, while the drug stays in the tumor area can be slowly released to play the role of local chemotherapy, which is called chemoembolization. This therapy has two main advantages: on the one hand, the high concentration of drugs can be injected directly into the local area to maximize the anti-tumor effect, with little toxic side effects on the whole body, so that most patients can receive the treatment; on the other hand, the blood supply vessels of the tumor are blocked, so that the tumor is deprived of blood supply and “starved to death”. This technique is especially suitable for malignant tumors of liver, lung, stomach, kidney, pelvis, bone and soft tissues that are out of surgery or not suitable for surgery. (ii) Non-vascular intervention. It is a technique to diagnose and treat many diseases by using various instruments under the guidance of medical imaging equipment such as X-ray, CT, B-ultrasound, MRI, through routes other than blood vessels, such as through the natural openings of human physiological cavities or direct percutaneous puncture of organs. Percutaneous non-vascular interventional techniques have the advantages of safety, effectiveness and few complications in the diagnosis and treatment of tumors. Non-vascular interventional techniques for tumors mainly include percutaneous puncture biopsy, lumen dilation and endoprosthesis, percutaneous puncture intratumor injection, percutaneous multi-electrode radiofrequency ablation and so on. Biopsy is mainly used in the diagnosis and differential diagnosis of tumor diseases in various parts of the body, while other techniques are mainly used in the treatment of obstruction in biliary system, digestive system and urinary system and the treatment of solid tumors. The main indications of malignant tumor interventional treatment. Vascular intervention: lung cancer, esophageal cancer, liver cancer, liver metastasis cancer, stomach cancer, kidney cancer, colon cancer, pancreatic and duodenal tumors, cervical cancer, ovarian cancer, bladder cancer, limb tumors, etc. Non-vascular interventions: percutaneous biopsy of solid tumors, intra-tumor injection of drugs for lung cancer and liver cancer, intraesophageal stent placement for esophageal cancer and biliary stent placement for bile duct cancer, etc.