Alban Denys is a French-Swiss interventional radiologist who was one of the founding members of the Society of Interventional Oncology (SIO). He has held the position of chairman of the European Conference on Interventional Oncology (ECIO) and developed and patented a chemoembolization method that includes anti-angiogenic agents. Passionate about mentorship and giving up-and-coming interventional radiologists quality fellowship opportunities, Denys is head of diagnostic and interventional radiology (IR) at the Centre Hospitalier Universitaire Vaudois (CHUV) in Lausanne, Switzerland. Interventional News spoke to him about his career highlights, research interests, and what is required to succeed as an interventional radiologist.
What attracted you to a career in IR?
I actually discovered IR by chance during my residency. I was lucky enough to be working at the Gustave Roussy Institute (IGR) under the supervision of Alain Roche with a bunch of other young fellows. At the IGR, I discovered a brand new field of medicine where image guidance could facilitate effective, yet less minimally invasive treatment. I had also found myself a little frustrated by diagnostic radiology, where there is not much close patient contact. IR was a way to be more directly involved in patient care.
Who were your mentors?
I am lucky to have had fantastic radiology mentors. Alain Roche in Paris and Michel Lafortune in Montreal have really impacted my work. Both are extremely patient-centred and are highly respected both in and outside of their specialty. Michel Lafortune has also shown me that academic medicine—coming up with ideas, and designing a study, and then publishing it—can bring me a lot of joy. I also love the interventional oncology (IO) family that I have met over the years: Bradford Wood, Riad Salem, Ricardo Lencioni, Patrick Chevallier, Thierry de Baere, Afshin Gangi, they are more than colleagues; we have had this shared adventure in the development of IR and IO. I have also welcomed fantastic fellows to Lausanne—the stars of today and tomorrow—including Rafael Duran and Boris Guiu, who are working together on CIRSE’s (Cardiovascular and Interventional Radiology Society of Europe) Interventional Oncology for Immuno-oncology (IO4IO) initiative.
Could you describe a particularly memorable case of yours?
The day that my oldest daughter came to the world, I received a call from my chief nurse whose daughter-in-law had just given birth to twins in a small clinic in a Parisian suburb. She had had a very severe form of postpartum haemorrhage, and she also had a coagulation disorder. The obstetrician had already left for the weekend and the ambulance could not transport her to the hospital because she was so haemodynamically unstable. I ended up embolizing her successfully in a very basic radiology room without any angiographic facilities, in the small clinic she was in. This was probably the most emotionally intense day of my entire life— there was the extreme happiness I felt at the arrival of our newborn, and then the stress of this intervention. I have kept a ‘basic embolization kit’ in my car ever since.
What are the most challenging aspects of using IR techniques to diagnose and treat liver cancers?
The real challenge is to develop an oncologic approach; to work out when best to perform an IO treatment, you actually have to develop skills and knowledge in both surgery and oncology. Our techniques have had to demonstrate their validity through strong medical evidence, too. Designing a trial, finding the money to run the trial and recruiting patients, all of these are tricky tasks.
This year’s ECIO featured the first IO foundation course—what is the significance of this for the future of IO and its practitioners?
This brings me back to my previous comment. We have to have an open dialogue with the oncologists we work with. This means understanding how they work and seeing things from their perspective, to then offer our solutions for the patients, at the right point in their treatment. But we should also be able to challenge oncologists’ decisions sometimes. And you can only do this if you have an in-depth knowledge of oncology. The IO foundation course is intended to equip our younger colleagues with this knowledge.
You patented chemoembolization composition including anti-angiogenic agents, which was then licensed for use in the VERONA study, now completed. What was the patent process like from your researcher’s standpoint?
Developing a new therapeutic concept, and building the preclinical evidence was extremely challenging. However, this was a lot of fun, even if finding money for experiments, going through the process of patenting, and then trying to license the product, was as exciting as it was difficult. In the end, the product licensed to BTG was approved for use in a clinical trial, which yielded interesting results. I also learned a lot from my exchanges with the industrial partners. Unfortunately, the project was not considered enough of a priority to be continued.
You recently published, in the Journal of Hepatology, a report on your experience with portal vein recanalisation? What do you think your results brought to the medical community?
This is actually the first large single-centre study of portal vein recanalisation in symptomatic chronic portal obstruction. This study reflects 15 years of practice in this rare and often misdiagnosed disease and demonstrates that this technique can be offered even after decades of portal obstruction. It leads to symptom and clinical improvement in 70% of cases and improves the nutritional status of patients. On the other side of the Atlantic, Riad Salem developed another treatment for the same disease. Time will tell whose is better.
During your professorship at CHUV Lausanne, what would you say the biggest shift in IR practice has been, both in your hospital and more widely? How has this impacted interventional radiologists’ approaches to cases and the consequent patient outcomes?
In 2018, we acquired an angiosuite combined with a computed tomography (CT) scanner in the same room. This kind of interventional suite has been used in Japan for years under the leadership of Professor Arai, but not much in Europe. This has been a game-changer in our practice for all procedures that require both angiography and percutaneous intervention. Of course, cone beam CT is also an option, but it has the disadvantage of being way more limited in term of imaging quality. We use our combined angiosuite and CT everyday and it has made us feel more secure and confident in our techniques, and probably also improved our clinical results.
Mentorship was the subject of this year’s Charles T. Dotter lecture at the Society of Interventional Radiology (SIR) Annual Meeting—why is this so important in IR and how can interventional radiologists seek to be better mentors?
Mentorship in every interventional or surgical activity is crucial; it is so important to be at young colleagues’ sides in the angiosuite. The transmission of all the tips and tricks of IR can only be done this way. The development of phantom and robotic IR will certainly change this approach in the near future, just like it did for laparoscopic surgery.
What are your hobbies and interests outside of medicine?
One of my main hobbies is biking, either in the Swiss mountains or in my beloved Normandy where we have a beach house. I also try to listen to live jazz music whenever I get the chance and I love reading books (particularly modern American authors like Jim Harrison). I am lucky enough to have been married for 30 years now, to a painter, and we enjoy visiting the museums and galleries in the places we visit on our travels, often with our children too.