Guest: Renan Uflacker - Interventional Radiologist
Host: Dr. Linda Austin
Dr. Linda Austin: I am Dr. Linda Austin and I am interviewing Dr. Renan Uflacker, who is Professor of Radiology and Director of Interventional Radiology at the Medical University of South Carolina. Dr. Uflacker, I know you have a very strong interest in recent years in radiologic treatment of liver cancer. My first question is when you are talking about liver cancer, are you treating patients who have primary liver cancer that is their cancer started in their liver or those who have had cancer spread from other site such as breast cancer patients or colon cancer patients.
Dr. Renan Uflacker: Actually both, we have been interested in the treatment of patients with primary liver cancer and patients with metastatic disease from other sources such as colon cancer and breast cancer.
Dr. Linda Austin: So typically then have your patients already been treated with chemotherapy or do you first use radiation therapy and then chemotherapy?
Dr. Renan Uflacker: It varies a little bit according to the type of cancer that the patient has. Most of patients with metastatic disease have had some type of previous treatment with chemotherapy or some type of other treatment and most of those patients -- we see our patient that have either recurrent tumors or tumors that do not respond anymore to chemotherapy treatment, so we have a few procedures that we can offer to those patients to treat regional cancer in the liver. The other population we see is the patients with primary liver cancer usually related to chronic liver disease such as cirrhosis and some other disease of the liver that develop a primary cancer, which are very resistant to treatment by chemotherapy. So, those patients don’t have a whole lot of options, so we offers some options for those patients such as radiofrequency ablation and chemoembolization and more recently in the last couple of years, intrahepatic radiation therapy with radioactive seeds.
Dr. Linda Austin: Three different procedures, let’s touch on each a little bit to try to understand. The first you said was radioablation, what do you do in radioablation?
Dr. Renan Uflacker: Radiofrequency ablation is a procedure where under local anesthesia and IV’sedation, you basically stick a needle inside the liver or the cancer inside the liver of the patient and you heat up that area, you deliver heat in that area through delivering radiofrequency energy and you kill the cancer cells and in that way, the tumor and the normal surrounding area of the liver will die and the whole tumor will be killed for that specific area. There are some other procedures also related to ablation such as cryoablation, which is actually delivering low temperatures within the tumor to kill by cold. So, there are different opportunities to treat the patients with different devices and techniques.
Dr. Linda Austin: It sounds like there are a number of options that you have at your disposal.
Dr. Renan Uflacker: That’s correct.
Dr. Linda Austin: I am sure that there is a variety of results from this. It’s always true with cancer; some patients do very well, others don’t. What we all love is success story. Can you tell us a story of a patient you have treated successfully with this technique where they have really had a good outcome and have a new lease on life?
Dr. Renan Uflacker: Yeah, sometimes we actually use a combination of techniques, radiofrequency ablation, chemoembolization, depends a little bit on the location of the tumor and the anatomy of the liver and so forth. We do have a success rate with this type of treatments of more than 80% of the patients actually respond to the treatment. There is a group of 15% to 20% of patients that don’t respond as well, but most of the time we were able to arrest the growth of the tumor. If you ask me for a success story, immediately comes to my mind a gentleman that we have been treating for six years now with one of the largest primary liver cancers we ever treated; it was more than 15 cm to 20 cm in diameter. We did a combination of treatments on him and he responded very well. The whole tumor shrunk and he is still alive six years later. So, we see him every six months and if something pops up, we go ahead and treat again. So, it is very important to do the treatment and do the followup with the patient so that we can detect whatever change in the cancer is happening.
Dr. Linda Austin: So, it sounds as if, let’s say for that gentleman and patients like that, if they respond and 80% do, you hope that their liver cancer will become more like a chronic disease that they come back and may need follow-up treatment and follow-up care, but you certainly have high hopes at least of extending their life and have quite a good success rate at doing that.
Dr. Renan Uflacker: That’s correct. One of the situations that we see with patients with primary liver cancer for example, our patients that have cirrhosis, so we almost always eliminate the cancer, but the disease of the liver is progressive. So, we increase the survival of those patients, but still the cirrhosis keeps going on and that’s going to be the problem for the future of those patients most of the time. It’s slightly different from patients with metastatic disease. They usually have a healthy liver otherwise and then if you are successful to treat the metastatic cancer, then you have a better opportunity to keep his liver function in a better situation than otherwise.
Dr. Linda Austin: Why is this technique particularly used for liver? Liver is a place that cancer often metastasizes too, but it also goes other places. Can we use these techniques on other organs besides liver?
Dr. Renan Uflacker: That’s correct. We can use that in some other area such as kidney. We have been treating usually patients with either small tumors or bilateral tumors; patients that have the tumors in both kidneys and sometimes it is preferable to treat them by ablation than by surgery because then you may hurt both kidneys if you do the open surgery. So, kidney tumor is another area where there has been a lot of development.
Dr. Linda Austin: Is it mostly soft organs liver, kidney, etc. as opposed to not bone?
Dr. Renan Uflacker: We can treat bones also. It depends on the location and size of the lesion. There is an opportunity to treat bone tumors and lung tumors. I have treated a couple of thyroid tumors also with that and you can also go for other organ such as uterine tumors and so forth. There is an opportunity for expansion of the treatment of cancer using those techniques.
Dr. Linda Austin: How about brain?
Dr. Renan Uflacker: We are not there yet. There is a technique that we are actually right now discussing with administration and with the Departmental Chair and some other departments, which is called the HIFU, high-intensity focused ultrasound, which is a machine that delivers ultrasound energy guided by MRI in different areas of the body. Right now, it has been approved by treatment of uterine fibroids and there are few centers in US that have that. We are planning to do a HIFU Center at MUSC and participate in trials and expand out for treatment of prostrate cancer, liver cancer, and perhaps pancreas and with that technology, it is possible to treat brain tumors, although the technology is still evolving in, so little early to looking those things, but there is already work started on that.
Dr. Linda Austin: Dr. Renan Uflacker, I really commend you on this very extraordinary effort that you have undertaken with such wonderful results and I am sure you have extended hope to so many patients with a typical disease.
Dr. Renan Uflacker: Thank you.
Dr. Linda Austin: Thank you very much.
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