Transarterial management of advance lung cancer

Abstract

Previous reports on transarterial treatment for lung cancer were reviewed. The bronchial arterial infusion therapy has a long history since 1964. Better local control with less doses of anti-neoplastic agents was warranted by trying transarterial administration to lung and mediastinal tumors. It is reported that both primary and metastatic tumors are fed by bronchial or other systemic arteries. The bronchial arterial embolization for hemoptysis has been introduced for clinical practice since 1973. Hemoptysis by not only benign but also malignant diseases has been well controlled by embolization. In recent decades, the technical elements for transarterial treatments have markedly improved. They make it possible to carry out precise procedures of selective catheter insertion to the tumor relating arteries. Current concepts of transarterial treatment, technical aspects and treatment outcomes are summarized. Tentative result from chemo-embolization for advanced lung cancer using recent catheter techniques was also described. It provides favorable local control and survival merits. It is considered that a population of lung cancer patients can benefit from transarterial management using small doses of anti-neoplastic agents, with less complications and less medical costs.

Keywords: anti-neoplastic agents; bronchial arteries; embolization; lung neoplasms; therapeutic.

Figure 1.

Cumulative survival curve of 82 patients with advanced lung cancer. Median survival time was 1.15 months.

Figure 2.

(A) Dynamic computed tomography (CT) in arterial phase. The tumor in the right lower lobe was adjacent to the diaphragm. Partial atelectasis of right lower lobe and pleural effusion were found. (B) A 3-D image was reconstructed from dynamic CT. The right bronchial artery (arrow 1) arises from the common trunk with intercostal artery (arrow 2). (C) Arteriography of right common trunk (arrow 2) and bronchial artery (arrow 1). A vague tumor stain (circle) was found in the right lower lobe. (D) A 3-D image of the right inferior phrenic artery (arrows). (E) Arteriography of the right inferior phrenic artery (arrow). Tumor stain (circle) was clearly found. (F) CT during selective arterial infusion into the right inferior phrenic artery. The tumor was clearly enhanced through the diaphragm. A total of 20 mg of cisplatin, 20 mg of docetaxel, 250 mg of fluorouracil and 100 mg of bevacizumab were infused through the right bronchial artery and right inferior phrenic artery. After infusion, embolization using 2.0 mg of Adriamycin loaded HepaSphere was done. (G) CT in 3 months after the initial therapy. Three sessions of treatment had been done, marked tumor regression was confirmed. No serious complications were found during and after the treatment. Respiratory symptoms were improved. (H) CT in 1 year after the initial treatment nine sessions of treatment had been done. The tumor was stable in size. The right pleural effusion had disappeared.

Figure 3.

(A) Contrast enhanced CT before treatment. Stenosis of superior vena cava (SVC, arrow) was caused by lymph node metastases (circles). (B) CT during contrast infusion through the right bronchial artery (arrow). Lymph node metastasis posterior to SVC was enhanced. Cisplatin (20 mg) and 5-FU (200 mg) infusion followed by embolization with HepaSphere (100–150:1.5 mg) was performed. (C) CT after 2 sessions of treatment. Re-opening of SVC (arrow) due to shrinkage of lymph node metastases was found. The SVC syndrome was completely improved. (D) CT after two sessions of treatment. Re-opening of SVC (arrow) due to shrinkage of lymph node metastases was found. The SVC syndrome was completely improved.

Figure 4.

(A) CT before treatment. Obstructive pneumonia was found in the right lower lobe. Transarterial chemo-embolization through two right bronchial arteries and right inferior phrenic artery was performed using 30 mg of cisplatin and 500 mg of 5-FU with 5 mg of HepaSphere (50–100). (B) CT in 2 months after treatment. Obstructive pneumonia was markedly improved according to shrinkage of tumor invading the pulmonary hilum. Symptoms caused by obstructive pneumonia were improved.