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BackTable / VI / Podcast / Episode #255

History of Ablative Procedures

with Dr. Luigi Solbiati and Dr. Steven Raman

In this episode, guest host Dr. Steven Raman interviews a founding father of percutaneous tumor ablation, Dr. Luigi Solbiati about the development of this revolutionary treatment, new therapies that have stemmed from it, and his vision for the future of interventional oncology.

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Varian
History of Ablative Procedures with Dr. Luigi Solbiati and Dr. Steven Raman on the BackTable VI Podcast)
Ep 255 History of Ablative Procedures with Dr. Luigi Solbiati and Dr. Steven Raman
00:00 / 01:04

BackTable, LLC (Producer). (2022, October 26). Ep. 255 – History of Ablative Procedures [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Luigi Solbiati discusses History of Ablative Procedures on the BackTable 255 Podcast

Dr. Luigi Solbiati

Dr. Luigi Alessandro Solbiati is Professor of Radiology at Humanitas University (Rozzano – Milan) and Consultant of Interventional Radiology at Humanitas Research Hospital.

Dr. Steven Raman discusses History of Ablative Procedures on the BackTable 255 Podcast

Dr. Steven Raman

Dr. Steven Raman is an interventional radiologist, the director of Prostate MR Imaging and Interventions, and the director of the UCLA Prostate MR Imaging Research Group.

Show Notes

Dr. Solbiati was a radiologist at the General Hospital of Busto Arsizio when he developed an interest in cancer in the 1980s. He traveled to the UK to learn about CT and ultrasound imaging. Upon his return to Italy, he combined this knowledge with his hospital’s department of pathology to obtain the first liver and abdominal ultrasound-guided biopsies for non-palpable lesions. Dr. Solbiati notes that in most of the world, ultrasound is personally performed by medical doctors, and it is an important skill to have.

Next, we discover how Dr. Solbiati came to treat the first parathyroid adenoma using percutaneous ethanol injection. After Dr. Solbiati had performed a parathyroid tumor biopsy, the treatment team realized that her serum PTH levels had completely normalized due to compression of the overactive parenchyma. Inspired by this result, Dr. Solbiati researched past literature and saw the success of ethanol injection to cause sclerosis of liver and renal cysts. Since the patient was not a surgical candidate, she was willing to undergo ethanol injection, which was eventually successful. Dr. Solbiati explains that parathyroid tumors are hypervasculated and encapsulated, so they are able to contain ethanol and prevent diffusion. Additionally, the use of ultrasound made it possible for operators to visualize the amount of liquid ethanol entering a solid tumor.

Overtime, Dr. Solbiati began to work with Dr. Tito Livraghi to inject ethanol and chemotherapeutics for hepatocellular carcinoma lesions. The outcomes from their initial studies are still used as benchmarks for locoregional therapies today. Their research gained publicity from scientific and non-scientific media, which came with both positive and negative reactions. Dr. Solbiati emphasizes the importance of collaboration with surgeons and other interventionalists to combine surgical, intravascular, and percutaneous therapies. Additionally, he also played a key role in the testing of cool-tip radiofrequency ablation.

Dr. Solbiati highlights the significance of percutaneous ablation in advancing health equity. Ethanol and radiofrequency ablation are relatively cost-efficient and safe, which allows for higher quality of cancer treatment in resource-limited settings. He looks toward the future of interventional oncology as the “fourth pillar” of cancer care (in addition to medical, surgical, and radiation oncological treatments), the growing use of augmented reality for percutaneous procedures, and the increasing rate of combination therapy with immunologic agents.

Resources

Percutaneous ethanol injection of parathyroid tumors under US guidance: treatment for secondary hyperparathyroidism (Radiology, 1985):
https://pubmed.ncbi.nlm.nih.gov/3889999/

Hepatic metastases: percutaneous radio-frequency ablation with cooled-tip electrodes (RSNA, 1997):
https://pubs.rsna.org/doi/10.1148/radiology.205.2.9356616

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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