Image-Guided Cancer Care: The Value of Interventional Oncology
By Orsi-Pereira, CIRSE
Imaging has transformed modern cancer care. Morphological, functional and molecular imaging, including MRI and PET/CT, can detect and characterise tumours, define their relationship with surrounding organs and assess treatment effects.
Interventional Oncology takes this progress one step further. It uses imaging not only to diagnose a tumour, but also to guide and monitor its treatment directly. The images become a real-time map for targeted, minimally invasive therapies adapted to the tumour and the individual patient: personalised medicine in practice.
During treatment, imaging allows the operator to monitor the instruments, the therapy as it is delivered and nearby healthy tissues. Imaging becomes part of the treatment, helping to target the tumour while preserving healthy tissue.
Interventional Oncology includes image-guided procedures such as tumour ablation, embolisation, intra-arterial therapies and supportive interventions used to control symptoms or manage complications caused by cancer and its treatments.
These therapies do not compete with surgery or systemic treatment. Depending on the clinical situation, they may complement or be combined with these approaches, or may be offered instead of surgery. Their role is to widen the options available within a multidisciplinary, personalised treatment plan.
An image-guided treatment may provide local tumour control, preserve organ function, reduce treatment burden or allow systemic therapy to continue. It may be appropriate when surgery is not feasible or indicated, or when a minimally invasive approach is preferable because of frailty, previous treatments or patient preference.
For some patients, this can mean a shorter hospital stay and faster recovery and less disruption to daily life.
Interventional Oncology can contribute throughout the cancer pathway. Its role begins with image-guided biopsy and tissue acquisition, providing material for diagnosis and molecular profiling. It extends to potentially curative or consolidative local treatment, management of oligometastatic or oligoprogressive disease, preservation of organ function, symptom control and palliation. Often its greatest value lies not in being used in isolation, but in being combined and appropriately sequenced with systemic therapy and other local treatments. In selected patients, local treatment can also control a limited site of disease while an effective systemic therapy is continued; in others, it can postpone the need to start or change systemic therapy, creating a systemic-treatment-free interval. This broader perspective is essential if precision cancer care is to encompass not only the tumour’s biological profile, but also its location, distribution and suitability for local treatment.
Another developing field is the interaction with the immune system. Tumour ablation and intra-arterial therapies can modify the tumour microenvironment and induce immune responses. Whether this can be translated into a clinically meaningful synergy with immunotherapy is an important area of ongoing research.
The question is therefore no longer whether Interventional Oncology has a role in cancer care, but whether European cancer systems are organised to use it appropriately.
Access remains uneven. Availability may depend on geography, local expertise and whether an interventional oncologist is involved in multidisciplinary decision-making. Even an effective treatment cannot benefit patients if it is not considered when their clinical pathway is discussed.
Image-guided cancer therapies should therefore be represented in tumour boards, clinical guidelines and cancer pathways, and Interventional Oncology should be included in multidisciplinary cancer education. Other cancer specialists do not need to become experts in interventional procedures, but they should know when these treatments may be relevant and when referral for specialist evaluation is appropriate.
Expanding access must go hand in hand with training, standards and continuous quality improvement. We support this through:
- the European Curriculum and Syllabus for Interventional Oncology,
- EBIR-IO specialist certification,
- IASIOS accreditation for Interventional Oncology services,
- and the European Conference on Interventional Oncology (ECIO)
There is also an issue of equity. Patients should not miss an appropriate treatment because image-guided therapies are unavailable locally or are not routinely discussed. Better referral networks, clearer pathways and greater awareness could reduce these differences.
Quality assessment should reflect this patient-centred role. Technical success alone is not sufficient. Relevant outcomes include local tumour control, complications, symptom relief, preservation of organ function, quality of life and patient-reported outcomes, as well as whether treatment allows systemic therapy to continue or avoids or delays a more invasive intervention. Measuring these outcomes consistently would strengthen the evidence base, support comparison and continuous improvement across centres, and help multidisciplinary teams identify which patients are most likely to benefit.
Closer collaboration between the European Cancer Organisation and CIRSE can support this integration. The aim is not to create another professional silo, but to ensure that multidisciplinary teams can consider the full range of treatment options.
Interventional Oncology is part of cancer care across Europe. More consistent integration into education, workforce planning, quality programmes and multidisciplinary pathways would make its contribution more visible, more accessible and, most importantly, more useful to patients.
