Melanie Cole (Host): The world of cancer care and treatment is evolving every day, and one growing component is interventional radiology and interventional oncology. Welcome to Bryan Health Podcast. I'm Melanie Cole. Today we're joined by Dr. Kyle Pfeiffer. He's an Interventional and Vascular Radiologist with Advanced Radiology.

Dr. Pfeiffer, thank you so much for being with us today. Tell us a little bit about interventional radiology and interventional oncology and how those are used throughout cancer care. It's a really exciting time in your field.

Kyle Pfeifer, MD: So let's just try to define maybe what interventional radiology is, in general. The way I like to describe interventional radiology and interventional oncology is a minimally invasive surgical subspecialty of radiology. And what that means is that we are Board Certified Diagnostic Radiologists that have received additional training to perform minimally invasive procedures all over the body, using those imaging tools that like CT scans, ultrasounds, x-rays, to help diagnose and treat disease.

Host: Well, thank you so much for defining that for us. Tell us about the main cancer treatments that you offer. What types of cancers does interventional radiology and interventional oncology treat?

Kyle Pfeifer, MD: So there's a few different cancers. One of the most common cancers is going to be something called renal cell carcinoma, which is a cancer that starts in the kidney and grows locally. The other main category is something called hepatocellular carcinoma, which is a cancer that starts in the liver and grows locally.

And then the other category would be liver metastatic disease. So those are cancers that have started somewhere else in the body and have spread to the liver where we can work on the metastatic disease burden in the liver itself.

Host: Well then tell us the benefits of these interventional radiology procedures for patients, because there's so much happening today, and it makes things a little bit easier, doesn't it?

Kyle Pfeifer, MD: It sure does. So one of the main advantages is that what we offer are very minimally invasive procedures. So things that in the past may have required a, a large incision and major recovery, can be done through small skin nicks in the skin, and oftentimes almost no recovery time or no hospitalization afterwards.

One of the other main advantages is that it provides options for patients that don't really have standard options. And what I mean by that is when patients present with cancer in the liver, whether that's a primary liver cancer or metastatic liver cancer, oftentimes they're not surgical candidates. Something like 80 plus percent of patients that present with that kind of disease are not candidates for standard surgical therapies. So this opens the door for a whole wide range of procedures for a whole population of patients that may not have other options.

Host: That's excellent to hear and so hopeful. And you mentioned liver cancer. So tell us specifically about the specialized ways that you can treat it and where that happens.

Kyle Pfeifer, MD: So there are two main categories of what we do for what we call liver directed therapy. Meaning we're actually doing procedures to target disease in the liver itself. The first category is something called an ablation, which is kind of a general term for using what's called a heating probe or a freezing probe to perform either a, a cryoablation, meaning freezing the tissue with this needle or heating up the tissue and destroying it locally. So those are the two different categories of what we would call ablation therapy. And then the second category is something called catheter directed therapy, which is working through the blood vessels in the liver to deliver either chemotherapy directly to tumors inside the liver or in another procedure, delivering very high dose radiation to these tumors inside the liver.

Host: I'd like you to expand on some of the exciting radiologic oncology that you do. Y90 has really broken onto the scene. Can you tell us a little bit about Yttrium and what it's doing, what you're using it for?

Kyle Pfeifer, MD: Absolutely. So Y90 is a very, uh, exciting area in interventional radiology and interventional oncology. It falls under the category of catheter directed therapy, meaning working through the blood vessels, mapping out the blood supply to the tumors that are in the liver, and then delivering, they're tiny little glass beads that have been impregnated with very high doses of a special form of radiation and those little tiny glass beads get delivered through the blood vessels into the tumor, and they lodge inside the small vessels inside the tumor called the capillaries and they sit there and they leak out this very concentrated form of radiation that can destroy those tumors locally.

Host: Isn't that amazing? Tell us a little bit about outcomes. How how have you seen this Y90 work?

Kyle Pfeifer, MD: So there's a few different clinical situations where Y90, it's called Y90 radioembolization is a technical term. A couple different clinical situations where this is helpful. One of the first situations is if someone is awaiting a liver transplant. Sometimes people will have disease in the liver and the only cure for it is going to be a liver transplantation.

Unfortunately, liver transplantation doesn't happen quickly. And if the disease in the liver gets too out of control, patients drop off that transplant list. So with Y90 radioembolization, we're able to downstage those tumors, we're able to shrink those tumors, oftentimes and keep people on the transplant list so they can actually get a new liver and have a cure in that form.

Another clinical situation where this comes up, is sometimes people just have one isolated spot in the liver and we're actually able to get complete tumor response, meaning the tumor completely dies and it goes away and it's curative. So that's the second example. And then the third clinical situation where this is useful, is more of a palliative approach, more of a salvage kind of therapy where patients have pretty much exhausted all their other options as far as chemotherapy or immunotherapy. And oftentimes we'll use the Yttrium, the Y90, as a form of salvage therapy just to see if there's anything we can do to try to decrease disease progression and increase patient survival.

Host: That is just absolutely amazing. And Dr. Pfeiffer, you have a few places where you perform these treatments. Tell us about those.

Kyle Pfeifer, MD: So we mainly are focused at Bryan East and Bryan West, in Lincoln, Nebraska. We perform all the Y90 radio embolizations at the Bryan West campus, but we're able to perform all these other interventional oncology procedures in the Bryan system. So here in Lincoln, out in Kearney in Grand Island, our practice is spread out across the state of Nebraska, so we're able to provide the majority of these therapies across the state.

Host: That's so helpful to the community and knowing cancer treatment takes really this multidisciplinary approach. How do you work with the oncologists and other physicians? How are patients able to receive these treatments? Speak about that multidisciplinary approach, tumor boards, all of it, so that patients understand how this navigation works and how you're really taking care of the patients that way.

Kyle Pfeifer, MD: So you're exactly correct. It is truly a, a multidisciplinary approach. So we kind of break it down into categories based on the organ system that's involved. So we have what's called hepatobiliary conference where we're talking about patients that have liver cancer like we've been talking about today, or pancreatic cancer or colon cancer.

We have like a thoracic tumor conference where we're talking about lung cancer, there's a breast conference, there's a genitourinary conference. So this is where all the experts in their fields, they come together and we present the patients and we talk about what options are and what best therapy would be for those individual patients.

Host: That really is the wave of the future in medicine. Do you have any final thoughts for patients about interventional oncology, interventional radiology, and the exciting advancements being made in this field today?

Kyle Pfeifer, MD: As far as recommendations for patients themselves, I'd say ask your doctor if you have a diagnosis of really any kind of cancer, it's worth exploring all of your options. The world of oncology and interventional oncology is changing every day, so, we're always trying to explore new options and really push the limits of what's possible for patients.

Host: As I said before, what an exciting time. Thank you so much Dr. Pfeiffer, for joining us and telling us about all these advancements in interventional radiology and patients be sure to talk to your doctor to find out if any of these treatments are right for your case. I'd also like to thank our Bryan Foundation partner, Glass Edge of Lincoln.

To listen to more podcasts from our experts, you can visit bryanhealth.org/podcasts. And that concludes this episode of Bryan Health Podcast. I'm your host, Melanie Cole. Thanks so much for joining us today.