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October 2007
An Interview with Dr. Constantinos Sofocleous

Groundbreaking procedures in Intervention Radiology:

An Interview with Dr. Constantinos Sofocleous Assistant Professor, Interventional Radiology, Cornell University

By Demetrios Rhompotis

Dr. Sofocleous joined UMDNJ in November 1999. He completed his radiology residency at St. Luke's-Roosevelt Hospital / Columbia University College of Physicians and Surgeons, and fellowship training in vascular and interventional radiology at New York University Medical Center. He received an RSNA research resident/fellow award in 1998 and an RSNA Cardiovascular Research Trainee Prize in 1997.

What is Interventional Radiology and what does it mean for patients?

Interventional Radiology is a unique specialty that combines imaging and surgical procedures. Unlike other specialties where the physician becomes a specialist in one organ or one disease, the interventional radiologist specializes in how to use technology in order to perform minimally invasive treatment in pretty much any part of the body, achieving results comparable to surgery while minimizing the risks.

Specifically for cancer patients it offers an additional treatment in the war against the disease. For example a patient with liver tumors that cannot be operated can now undergo embolization (cutting of the blood supply to the tumor) via a tiny needle puncture in a groin artery that will allow the interventional radiologist to travel with special catheters (small tubes) into the liver and select the vessel that goes to the tumor and then obstruct it. This approach minimizes the effects of the procedure on the entire body while maximizing the killing effect on the malignant tumor. Whether it is a biopsy or an ablation (killing of tumor by local application of heat or cold energy through a needle), interventional radiology has the ability to treat while minimizing the overall impact on the patient.

How were you involved in its development?

While in Greece, in the University of Athens Medical School almost 20 years ago, I was fascinated by the development of imaging and its ability to guide procedures and save the patient from the need of undergoing surgery. This fascination made me pursue a career in interventional radiology. I was fortunate enough to acquire all of my training in interventional radiology in outstanding institutions in NYC such as Columbia and NYU. Early in my training I got involved with clinical research comparing different minimally invasive treatments against thrombosis. While in my fist faculty appointment I got involved with the application of radiofrequency ablation for the treatment of cancer without surgery. My interest on interventional oncology kept growing and in 2002, I joined the interventional radiology faculty of Memorial Sloan Kettering Cancer Center. Here I continued to explore and apply alternative treatments for the eradication of cancer, such as embolization and ablation. In a group of very bright and talented specialist we undertake multiple projects every year in an effort to improve clinical care and find new and better ways to treat cancer. Recently we set-up a study comparing the effect of embolization (blocking the blood vessel) with or without chemotherapy. In a different project we perform tissue examinations in an effort to detect early cancer recurrence after treatment with ablation.

Are you working on other innovative ideas right now?

My current research interest involves the combination of these treatments in order to maximize the therapeutic effect while minimizing the complications and side effects. A very unique and particular area of my current research involves methods of evaluating the results of radiofrequency ablation by early tissue examinations. This allows early detection of residual cancer that can be then treated before it grows back. In addition I am in the process of introducing a new treatment called radioembolization for the treatment of liver metastases from colon cancer or other types of malignancy. This is a very new and evolving treatment that combines local radiation into the tumor by delivering small radioactive spheres in the tumor via a catheter placed in the artery supplying the tumor. In this manner the radiation effect in the tumor is maximized and the effects in the rest of the body are minimized.

How close are we to curing cancer once and for all? Despite the new advancements it seems that new kinds of cancer appear all the time.

Cancer and disease in general is part of the human genetic code and life! It is like anything else in life; you can postpone or modify it, but probably not cancel it for good! I wish we could. Daily progress is made and new treatment is found and applied in every field of medicine. Cancer is no exception and research in the field is strong. But cancer modifies itself constantly and finds ways to break through. We consider it a success when we keep a patient with fatal cancer alive and with good quality of life for many years. This is especially rewarding when you are dealing with disease that would otherwise result in death within months of diagnosis.

As a doctor, but also as a human being, how do you manage to cope with the multi-faceted demands of your job? Besides your service as a scientist, how do you provide the human touch to a patient?

It is absolutely important to maintain a human touch and true compassion for every and each patient that you treat. This is of paramount significance in building and maintaining trust in the doctor-patient relationship. This definitely contributes to an improved response to treatment and healing. In daily practice it is important to remember that you are dealing with human beings like you. So, I try to treat everyone as I like to be treated by others. A smile and a gentle touch have an enormous effect in all aspects of human interactions. And when you are a treating physician with patients there is no difference.

Another important point to remember with patients is that you always have to treat them with respect. Inform them about all possible options and alternatives and always listen and follow their desires regarding their treatment.

Are you happy with the state of medical services in this country? People tend to complain about HMOs and not being able to get the kind of care they want and deserve and also about the lack of a universal health insurance. Since you are also aware of the European experience on the matter, where things are done differently, what do you think needs to be done here?

This is a very difficult question for anyone to answer. There is no panacea when it comes to this. There are many different health systems and all have weaknesses and advantages. When thinking about health care it is necessary to remember that the goal is to provide the best quality service to everyone that needs it. This is the ideal. However the growing expenses of health care are related to enormous administration costs, the lack of investment in preventive medicine and the continuing introduction of hi tech applications into medicine. The American system suffers when it comes to people without insurance but many European systems suffer too. It is not uncommon to hear stories of bankrupt national health systems or complaints about the very low quality health care and long waiting times for medical services in many European countries. Health care certainly needs a reform so that patients in need and particular non-employed patients or children have access to good quality medical services as they need them.

Which patients are candidates for your services and how can they reach you?

All patients with cancer are potentially eligible for interventional oncology services. From the first step of a biopsy to make a diagnosis to the latest treatment with ablation of a liver, lung, bone or kidney cancer a patient may benefit from a consultation and possible intervention. I suggest that patients visit the website www.sirweb.org where they can read about many of the procedures we perform in detail. In addition they can visit the Memorial website at www.mskcc.org and look up information for any type of cancer. In addition they can look-up any physician working in Memorial Sloan Kettering Cancer Center. Finally if a patient thinks is a candidate for, or wants to know more about interventional oncology and alternative treatment he can conduct me via email at sofoclec@mskcc.org or call to schedule a clinic visit for a face to face consultation and examination at 212-639-6610.

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