Monday, November 24, 2014
Interventional radiologist William Alago discusses minimally invasive procedures, advances in imaging techniques, and the future of his field.
William Alago is used to patients looking at him quizzically when they first meet him. An interventional radiologist who practiced at several New York–area hospitals before arriving at Memorial Sloan Kettering eight years ago, Dr. Alago is acutely aware that though his medical specialty is increasingly useful in cancer diagnosis and treatment, many people don’t understand it — including those who might benefit most from it.
He usually explains his job in simple terms, mindful that his patients are undergoing either biopsies to potentially pinpoint a malignancy or therapies to eradicate one. “I tell them that interventional radiologists are like image-guided surgeons who do minimally invasive procedures through tiny pinholes in the skin,” he says. “Usually, these procedures don’t require general anesthesia and offer a level of precision that’s quite unique with a very low complication rate.”
Using imaging techniques such as CT scans, ultrasounds, or x-rays, Dr. Alago and his colleagues often work within blood vessels, employing novel treatments to destroy tumors or implanting filters to prevent blood clots from migrating from the legs to the lungs, for example. They also facilitate other therapies by placing chest ports or catheters that improve patients’ ability to receive intravenous drugs.
In this interview, Dr. Alago discusses compelling advances in his specialty, its popularity among medical students, and his efforts to promote cancer screening among minorities.
Which interventional radiology techniques do you use most often to treat cancer?
On the treatment side, we most often perform embolization, which treats tumors by injecting small beads into vessels that supply blood flow to cancers in the liver. The beads can be filled with either radioactivity or chemotherapy, depending on the cancer type. We often use so-called “bland” particles that have no chemotherapy in them and work just by blocking a blood vessel that feeds the tumor.
We also frequently use a procedure called thermal ablation, which inserts needle-like probes to burn or freeze tumors in their place. That’s invariably done with image guidance using small holes in the skin and can help prevent tumors from growing. Research has shown this technique is useful in several types of cancer, including kidney, lung, and liver. We also use it in bones either to relieve pain or to keep metastases under control.Back to top
How has the field changed in recent years?
There’s really been an incredible growth in the field in the last ten years. Because interventional radiology has become so useful in cancer, it’s become one of the more popular specialties in medicine as well as oncology. We get trainees as young as college age.
The specialty is really only 40 years old — and for medicine, that’s young. Thankfully, some of the field’s pioneers are still around and can help us along. In our own department at MSK, Karen Brown was one of the first interventional oncologists to advocate the use of bland embolization for liver cancer. The popularity of these techniques has allowed us to grow from six to 16 attending physicians in the eight years I’ve been here.Back to top
What interventional radiology treatment has changed the complexion of cancer care more than any other during your career?
Beyond embolization, I also like to point out thermal ablation. I think the ability to make a pinhole incision in a patient and burn the cancer in its place — especially in a patient who can’t undergo conventional surgery — is an amazing advancement. I just saw two patients today for thermal ablation for lung cancer, one that spread from a colon cancer and the other a primary lung cancer.
Both of these patients weren’t operative candidates, so to be able to offer them what is likely to be a same-day procedure to kill their cancer in one day with a small needle inserted with image guidance is remarkable. At the moment, we know these procedures are life extending, but studies are bearing out that in certain situations, these cancers can also be cured.Back to top
You also practice part-time at MSK’s new West Harrison location. Do you think this facility will improve the experience for patients in the Westchester community?
Definitely. Regional cancer centers like this are important for patients because it can be exhausting to travel back and forth to New York City, and many of our patients come from surrounding areas to the north. This means less wear and tear and less expense for them. The services we now offer at West Harrison include image-guided diagnostic biopsies, placement of ports for chemotherapy, and palliative techniques such as draining abnormal fluid pockets with catheters. In the future, we plan to expand these services to include targeted image-guided treatments to control local tumor growth.Back to top
Why did you decide that promoting cancer screening guidelines in minority communities would be one of your professional priorities?
As an underrepresented minority doctor — I’m of Puerto Rican background and was born in the South Bronx — I’ve made it a point since medical school to not only increase the pipeline of minority physicians but also advance the public health interest and care for minority and underserved populations.
Since I deal with so many different types of cancers and know the screening guidelines for each, I figured I would make my voice heard on the importance of screening and early detection. That’s unfortunately been a problem in underserved populations, which tend to have later-stage disease that’s less treatable when first diagnosed. I feel good about being at an institution like this that helps me advance this particular public health intervention.Back to top
What are your future goals?
I really want to increase my government lobbying efforts. As part of my involvement with the Society of Interventional Radiology, I speak to members of Congress to increase their awareness that this is a viable, growing specialty that will play a major role in healthcare economics in the future. If we can convince them that our minimally invasive procedures get patients out of the hospital faster and offer long-term results, it would help advance the specialty of interventional radiology across the country.Back to top