Interventional Oncology -- Combinational Technologies Play a Crucial Role for the European Outlook
LONDON, July 10, 2013 /PRNewswire/ -- A decade ago, there was little interest in interventional cancer therapies. Five years ago, newly diagnosed cases of different types of cancer stood at about 12.7 million with 7.6 million related deaths registered. According to the WHO GLOBOCAN database, the top three diagnosed cancer forms in 2008 included lung – 1.61 million, breast – 1.38 million, and colorectal – 1.23 million, while the most common types of cancer with leading death rate were lung – 1.38 million, stomach – 0.74 million, and liver – 0.69 million.
These alarming statistics have made interventional oncology a rapidly evolving speciality. Traditional surgical techniques are now increasingly being replaced by minimally invasive imaging-guided procedures. Primary interventional techniques include thermal ablation, high intensity focused ultrasound (HIFU), and embolization.
Radiofrequency ablation (RFA) and cryoablation are already considered sound treatment options, while transarterial chemoembolization (TACE) is probably the worldwide standard for treatment of unresectable hepatocellular carcinoma, with drug-eluting beads being the first major technology advancement in TACE. Microwave ablation (MWA), irreversible electroporation, and HIFU are evolving interventional technologies.
"The popularity of interventional technology is increasing; looking into the future, the medical fraternity is considering it as a major treatment possibility," said Frost & Sullivan Healthcare Senior Analyst Akanksha Joshi. "Cost effectiveness and improvement in quality of life are the main merits achieved with interventional oncology."
Although surgery remains the standard treatment method for most forms of cancer, there is ample space for new technologies to be implemented. MWA has introduced advantages over RFA and is steadily growing in sales. Selective internal radiation therapy (SIRT) and HIFU too are gaining ground due to clear benefits like targeted therapy and non-invasiveness, respectively.
"Presented as the most accurate and patient-friendly procedures that are applicable to a wide patient base, TACE, HIFU and SIRT are in the growth phases and likely to gain a much larger market share in the future," noted Joshi. "Unfortunately, treatment methods using ablation technologies and SIRT have little or no reimbursement in Europe despite the clear demand for minimally invasive and non-invasive methods that increase patient comfort, reduce patient hospital stay, and hence decrease treatment costs for both hospitals and patients. Surgery continues to be the trusted and globally reimbursed mode of treatment for cancer."
Further, full clinical evidence for the effective use of new technologies is still lacking. Most studies are vendor sponsored which means parameters to evaluate the device vary and results may thus not be unbiased.
Increasing investment in research will improve existing devices and technologies' output. For instance, tissue overheating during MWA may be avoided by implementing power control algorithms, and advanced ergonomic devices are being designed with instinctive controls and features.
Manufacturers will greatly benefit from the fact that many interventional oncology technologies can be used as combinational technology. Numerous possibilities have been researched, such as heat activated liposomal doxorubicin with RFA. Similarly, both HIFU and RFA help in the deposition of doxorubicin. Studies also indicate that the combination of technologies such as RFA with TACE, or percutaneous ethanol injection (PEI) with RFA or TACE provides better-quality treatment. Clinical trials are currently being performed to prove the efficacy of such combined technologies.
"Availability of reimbursement for interventional oncology technologies would make them more popular as combinational technologies," stressed Joshi. "This trend would favour the use of different techniques as per necessity and benefit of patients."
Going forward, image-guided multimodality routing, computerisation and visualisation, along with electromagnetic radiation, drug delivery and immunotherapy, are expected to play a pivotal role in curing cancerous tissues. Methods gaining popularity in this treatment space include image-guided stereotactic radiotherapy with modern methods of respiratory synchronization.
For now, combinational technology will offer medical oncologists a choice of additional treatment, although there still remains a need to search for a technology that can substitute surgery. Collaboration between the science and medical communities, and manufacturers will pave the way for an effective treatment solution.
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