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if required is performed. Selective Internal Radiation Therapy

(SIRT) is a technique where microspheres of radioactive material such as Yttrium 90 are injected into the tumour vessels. Complications of TAE, TACE and SIRT include post-embolization syndrome, non- target embolization, infection, liver failure and radiation related side effects. Arterial embolization is also performed in other malignancies like renal cell carcinoma, angiomyolipoma of the kidney.

Renal tumours Renal artery embolization is indicated in symptomatic haematuria in renal cell carcinoma and for palliation (see

 Liver, renal and lung tumours are currently being treated by tumour ablation techniques


figures 3&4). Pre-operative embolization in hypervascular tumours may be performed to reduce the tumour bulk. Embolic agents used commonly are PVA particles, absolute alcohol, Spongastan (gelfoam) and Coils.

Skeletal metastases Metastases to the bone, usually from renal tumours, are embolized prior to surgery to reduce the vascularity thereby reducing blood loss (see figures 5&6). Complications include non-target embolization, skin necrosis and nerve palsies, however these are rare with careful selective catheterization of tumour feeding vessels.

Soft tissue tumours Soft tissue sarcomas are highly vascular and embolization of these tumours achieves devascularisation partially or completely. This aids in reduced tumour size, and decreased blood loss during surgery. Operative procedures are usually planned one or two days following embolization.

Ablative techniques Tumour ablation can be performed with chemical ablation, RFA/microwave ablation, cryo therapy and HIFU. These procedures are performed under image guidance, usually ultrasound or CT and occasionally MRI. In chemical ablation, absolute alcohol

is directly instilled into the lesion/vessels through a catheter. RFA, microwave and cryo therapy involve placing a probe under image guidance into the tumour and treating the lesion with appropriate heat or cold temperatures. HIFU is an emerging technique where tumour necrosis is achieved by utilizing ultrasound waves focused onto the tumour. Liver, renal and lung tumours are currently being treated by tumour ablation techniques.

Palliative procedures-Gastro intestinal Obstructive symptoms can be relieved by stent insertion. Oesophageal, gastric, duodenal, small bowel and colonic stenting are performed in malignant strictures to relieve obstruction. In patients with oropharynageal tumours who cannot swallow, percutaneous radiological insertion of gastrostomy (RIG) is performed to allow for feeding. Complications of stenting include bowel

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