In Brief | Interventional Radiology | Oncology | Palliative Care
The Role of Interventional Radiology in Palliative Care: Enhancing Quality of Life
Time to read: 04:51
Time to listen: 08:52
Source: Original
Type of article: Narrative
MedED Catalogue Reference: MRN002
Category: Intervnentional Radiology
Cross Reference: Oncology, Palliative Care
Keywords: oncology, interventional radiology, palliation, ablation, obstruction
Key Takeaway
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Interventional radiology (IR) has become an integral component of palliative care, offering a range of minimally invasive procedures aimed at alleviating symptoms, improving quality of life, and enhancing comfort for patients with advanced or terminal conditions. These procedures are particularly beneficial for managing complications that arise in patients with oncological or non-oncological diseases, where conventional treatments may be limited or less effective.
Biliary Obstruction Management
One key application of interventional radiology (IR) in palliative care is the management of obstructive symptoms such as biliary obstruction, ureteral obstruction, and gastrointestinal stenting.
A majority of patients presenting with malignant biliary obstruction have an underlying carcinoma of the pancreas or gallbladder. In some cases, metastatic lymph nodes at the hepatic hilum or peripancreatic region can compress the proximal common bile duct, resulting in significant obstruction. This leads not only to progression of the primary malignancy but also to debilitating symptoms such as severe pruritus due to impaired bile drainage.
Percutaneous biliary interventions play a critical role in providing relief, especially in high biliary obstructions, where endoscopic access may be limited. Endoscopic approaches are typically preferred for lower biliary obstructions. However, percutaneous techniques are also indicated in low obstructions in patients who have undergone surgeries such as pancreaticoduodenectomy, where altered anatomy renders endoscopic access technically challenging.
Percutaneous transhepatic biliary drainage involves selective cannulation of the biliary system under image guidance, followed by catheter manipulation and placement of a drainage catheter or stent. This facilitates either internal or external bile drainage and allows for gradual biliary decompression. Over time, the goal is to achieve internal drainage via stenting, typically using self-expandable metallic stents.
Additionally, percutaneous nephrostomy is commonly employed to manage ureteral obstruction, preventing renal failure and offering relief from pain and infection. Gastrointestinal stenting can also alleviate symptoms related to malignant bowel obstruction, improving oral intake and reducing the need for nasogastric tubes.
Tumor Ablation
In oncology, tumour ablation techniques—including radiofrequency ablation (RFA), microwave ablation, and cryotherapy—are increasingly used in palliative care. These procedures are effective for reducing tumour burden and alleviating symptoms, especially in the liver, lungs, and bones. RFA, for instance, uses electromagnetic energy to heat tissue above 60°C, resulting in localised cell death.
It is safe and widely used for treating hepatocellular carcinoma (HCC) and colorectal liver metastases, with low mortality and complication rates. In palliative settings, RFA can also relieve pain from bone metastases resistant to radiotherapy.
Embolisation Techniques
Embolisation techniques, including transarterial embolisation (TAE) and transarterial chemoembolization (TACE), are valuable tools for controlling bleeding and managing hypervascular tumours.
TACE is a standard treatment for intermediate-stage HCC (Barcelona Clinic Liver Cancer stage B). It involves selective hepatic artery cannulation, followed by infusion of a chemotherapeutic agent directly into the tumour bed and subsequent embolisation.
Thanks to the liver's dual blood supply, the ischemia produced enhances the cytotoxic effect while sparing surrounding liver tissue. TACE achieves higher local drug concentrations and lower systemic exposure compared to systemic chemotherapy and, when combined with ablation, has been associated with improved overall survival.
Embolisation also plays a critical role in managing haemorrhagic complications.
Approximately 10% of patients with lung cancer may present with massive haemoptysis—bronchial artery embolisation can be lifesaving in these cases. Similarly, embolisation is successfully used to control bleeding in ruptured HCCS, retroperitoneal tumours such as angiomyolipomas and renal cell carcinomas, and severe haemorrhagic cystitis (e.g., from cyclophosphamide use or pelvic radiotherapy) that is refractory to conservative management.
These interventions provide rapid symptom control and often eliminate the need for more invasive surgical procedures.
Pain Management
Pain remains a major source of morbidity in patients with advanced cancer, significantly impairing quality of life. While opioids and other strong analgesics remain the cornerstone of pain management, following the World Health Organisation's analgesic ladder, their side effect profiles and variable efficacy, especially in neuropathic pain, present challenges.
Interventional radiology offers a valuable adjunct for pain relief, particularly in cases where conventional pharmacologic therapy falls short.
These procedures can be performed under fluoroscopic, ultrasound (US), or CT guidance, with technique selection guided by operator expertise. Minor complications, including transient diarrhoea and orthostatic hypotension, are generally manageable.
Peripheral nerve blocks also offer targeted relief for various malignancies, reducing reliance on systemic analgesics. In the context of metastatic bone disease, where pain can be severe and sometimes refractory, radiotherapy has been a mainstay, providing partial relief in up to 70% of patients.
However, for those unresponsive to radiation or where it is contraindicated, interventional options play a critical role.Percutaneous ablation—such as radiofrequency or microwave ablation—is increasingly endorsed in guidelines (e.g., NCCN) for treating painful bone metastases when other options are unsuitable.
Together, these IR techniques enhance the palliative toolkit, offering minimally invasive, effective, and patient-centric options for cancer-related pain that can significantly improve quality of life in advanced disease.
Conclusion
The integration of IR into palliative care enables tailored, minimally invasive interventions that patients with advanced disease can tolerate well. These procedures can often be performed under local anaesthesia, allow rapid recovery, and avoid the morbidity associated with surgical approaches.
While challenges such as patient selection, interdisciplinary coordination, and procedural risks remain, IR has made substantial contributions to improving symptom relief and functional status in palliative care.
Sources
Angcahan DZ, de Guzman AB. Palliative care and interventional radiology for older adults during the COVID-19 pandemic. J Med Imaging Radiat Sci. 2022 Jun;53(2 Suppl):S18-S21. doi: 10.1016/j.jmir.2022.03.002. Epub 2022 Mar 8. PMID: 35346611; PMCID: PMC8901376.
Campbell TC, Roenn JH. Palliative Care for Interventional Radiology: An Oncologist's Perspective. Semin Intervent Radiol. 2007 Dec;24(4):375-81. doi: 10.1055/s-2007-992325. PMID: 21326589; PMCID: PMC3037252.
Dhamija E, Deshmukh A, Meena P, Kumar M, Bhatnagar S, Thulkar S. Complementary Role of Intervention Radiology in Palliative Care in Oncology Setting. Indian J Palliat Care. 2019 Jul-Sep;25(3):462-467. doi: 10.4103/IJPC.IJPC_24_19. PMID: 31413465; PMCID: PMC6659525
Fletcher, A., Moore, K. J., Stensby, J. D., Hulbert, A., Saemi, A. M., Davis, R. M., & Bhat, A. P. (2021). The Pain Crisis: Interventional Radiology's Role in Pain Management. AJR. American journal of roentgenology, 217(3), 676–690. https://doi.org/10.2214/AJR.20.24265
Lu J, Zhao M, Arai Y, Zhong BY, Zhu HD, Qi XL, de Baere T, Pua U, Yoon HK, Madoff DC, Teng GJ; International Society of Multidisciplinary Interventional Oncology (ISMIO). Clinical practice of transarterial chemoembolization for hepatocellular carcinoma: consensus statement from an international expert panel of International Society of Multidisciplinary Interventional Oncology (ISMIO). Hepatobiliary Surg Nutr. 2021 Oct;10(5):661-671. doi: 10.21037/hbsn-21-260. PMID: 34760969; PMCID: PMC8527415.
Prater S, Zayas JO. Percutaneous Radiofrequency Ablation of Liver Tumors. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557730/
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