Interventional Oncology at the National Cancer Institute in Brazil: An Interview With Jose Hugo Mendes Luz, MD

At the 2014 Synergy interventional oncology meeting in Miami, Florida, Interventional Oncology 360 spoke with editorial board member Jose Hugo Mendez Luz, MD, from the National Cancer Institute (INCA) in Rio de Janiero, Brazil, about the interventional oncology therapies performed at his institution. 

One of the therapies provided at INCA is intra-arterial chemotherapy for children with retinoblastoma. Dr. Luz explains that before surgeons resort to surgically removing an eye in a child with retinoblastoma, the patient receives chemotherapy via a microcatheter in the retinal artery. Results have been positive, according to Dr. Luz, who says that only 1 of 7 children treated so far with the therapy at INCA went on to have an eye removed. Below, Dr. Luz describes intra-arterial chemotherapy for pediatric retinoblastoma as well as other minimally invasive therapies provided for cancer patients at INCA. 

Q: Tell us about your facility and the interventional oncology procedures provided there.

A: I’m an interventional radiologist and I work mostly with oncology diseases and therapies. Most of the procedures we perform are related to cancer, including biopsies, CT-guided biopsies, ultrasound-guided biopsies, drainage of all types such as abdominal drainage and biliary drainage, vena cava filter placements, transarterial chemoembolization, embolization, preoperative embolization, liver ablations, lung ablations, bone ablations, kidney tumor ablations, some more rare procedures that are also directly related to cancer, such as intra-arterial therapy for retinoblastoma in children. That’s a unique part of our work at INCA, the National Cancer Institute. We also started doing splenic embolization for patients who experience low platelet counts during chemotherapy. 

Q: Could you describe the minimally invasive pediatric retinoblastoma therapy?

A: At the National Cancer Institute we see many children with retinoblastoma, and at our institute after they fail first- and second-line chemotherapy, and they cannot be treated with laser, before they go for surgery to remove the eye, they go for intra-arterial chemotherapy infusion for retinoblastoma. This is done in our department with a microcatheter placed in the retinal artery, and we infuse the therapy, which is usually 3 drugs prescribed by the pediatric department. This is a 2-hour procedure that we perform 6 times, and we’ve seen very good response. Of 7 children already treated, only 1 child has gone on to have surgery to remove the eye. So it’s a very specific treatment and very rare. We’re the only public hospital in Brazil that is doing this type of treatment, but this treatment is also done in Argentina. We had very good results, which are checked with the ophthalmologist, who does direct examination of the eye and checks response. 

Q: How are interventional oncology patients referred to you, or  how do patients come to you for treatment?

A: At our cancer institute, which is a public department in Brazil, patients can access the hospital directly, if they know about it. If they don’t, they go to a primary clinician at a public hospital in Rio de Janiero or elsewhere. Any patient can be treated at the National Cancer Institute from any state. A primary care clinician will decide if they need treatment at INCA or not, and if so then the patient will be referred to INCA and will be scheduled with the specialty that will take care of his or her disease. 

Patient cases are discussed in our tumor board meetings. At this meeting now we have the surgeon, the clinical oncologist, the diagnostic radiologist, and myself, the interventional radiologist, for discussion. It is an improvement in patient care that today the interventional radiologist is present in the multidisciplinary discussion. 

Q: Are there any research studies going on now at INCA?

A: There are a few ongoing trials at INCA. One of them is the splenic embolization trial, a prospective trial that is ongoing. Every patient whose platelet count is below 90,000 is referred to our department for splenic embolization. We’ve treated 18 patients. All patients had platelet counts increase after the procedure. The procedure is simple – it takes less than an hour and patients are discharged the same day or the next day. Our goal with this procedure is to make that patient able to return to systemic chemotherapy as quickly as possible. Another study is on the intra-arterial chemotherapy for retinoblastoma in children. It’s a retrospective study analyzing the 7 patients we treated already.

A third study is on portal vein embolization, another procedure we do on a regular basis at INCA. We have treated 32 patients and we hope to publish the results. Some interventional radiology departments use coils, but our experience is mostly with glue, which in Brazil is less expensive than coils. We’ve been using glue for the last 3 to 4 years with very good results, and that’s only possible because interventional radiology is now working together with surgery and clinical oncology departments. 

Q: Have you seen an evolution in interventional oncology over the years?

A: Interventional oncology has changed. That’s impossible not to see. I think my own path in medicine is very close to that of interventional oncology. At my hospital 10 years ago we had only 2 doctors doing procedures, me and my fellow, and we performed only biopsies and biliary drainage. That was not so long ago. And now 10 years later we have 4 full-time interventional radiologists doing all kinds of procedures, helping many more patients. 

That represents exactly what interventional oncology has achieved in the last 10 years: enormous growth that has translated into more beneficial care for patients, faster diagnostic procedures, and more available therapies, even in South American countries. So interventional oncology has evolved. Where I work that’s very clear. We had only one nurse, and now we have a nurse team of 15 people, 4 full-time doctors, 4 fellowship doctors every year. It has evolved, and for the better. 

Suggested citation: Ford J. Interventional oncology at the National Cancer Institute in Brazil: an interview with Jose Hugo Mendes Luz, MD. Intervent Oncol 360. 2014;2(12):E92-E94.