Image-Guided Percutaneous and Transarterial Therapies for Primary and Metastatic Lung Cancer

Abstract

Lung cancer is the leading cause of cancer mortality in the world. A significant proportion of patients with lung cancer are not candidates for surgery and must resort to other treatment alternatives. Rapid technological advancements in fields like interventional radiology have paved the way for valid treatment modalities like image-guided percutaneous and transarterial therapies for treatment of both primary and metastatic lung cancer. The rationale of ablative therapies relies on the fact that focused delivery of energy induces tumor destruction and pathological necrosis. Image-guided percutaneous thermal ablation therapies are established techniques in the local treatment of hepatic, renal, bone, thyroid, or uterine lesions. In the lung, the 3 main indications for lung ablation include local curative intent, a strategy to achieve a chemoholiday in oligometastatic disease, and recently, oligoprogressive disease. Transarterial therapies include a set of catheter-based treatments that involve delivering embolic and/or chemotherapeutic agents directed into the target tumor via the supplying arteries. This article provides a comprehensive review of the various techniques available and discusses their applications and associated complications in primary and metastatic lung cancer.

Keywords: drug-eluting beads; lung cancer; percutaneous ablation; transarterial chemoembolization.

Figure 1.

Microwave ablation in an 80-year-old man with thymoma and lung metastasis. (A) CT scan of chest shows a lung nodule in the right middle lobe of the lung (white arrow). (B) The lung nodule measures 1.46 cm in diameter and is located 12.54 cm from the potential entry site of the probe. MWA probe is inserted into the lung nodule (C), with a 4 min MWA at the power of 65 W, and (D) post ablation CT showing limited alveolar hemorrhage. (E) Follow-up CT scan after 6 months shows scare tissue in the region of the treated tumor. Abbreviations: CT, computed tomography; MWA, microwave ablation.

Figure 2.

Cryoablation of a lung metastasis in a 66-year-old woman with metastasis from cholangiocarcinoma. (A) CT image shows a lung nodule in the right upper lobe (white arrow). (B) The lung nodule measures 0.7 cm in largest diameter and is located 4.77 cm from the skin. (D) Cryoablation probe insertion followed by 3, 7, and 10 min freezing with interval passive thaws (total freezing time of 20 min). (E-F) Focal intranodular and limited alveolar hemorrhage occurred during and after cryoablation. (G) Follow-up CT images after 6 month shows stable lung nodule in the treated area. Abbreviation: CT, computed tomography.

Figure 3.

The pulmonary artery and its branches.

Figure 4.

The most common anatomical variations of the bronchial arteries with reported incidences. Type I is the most common variant with two left bronchial arteries and one right bronchial artery off an (ICBT). Type II has one left bronchial artery and one right bronchial artery off an ICBT. Type III has two left bronchial arteries and two right bronchial arteries with one from an ICBT. Type IV is the least common variant with one left bronchial artery and two right bronchial arteries with one from an ICBT. Abbreviation: ICBT, intercostal-bronchial trunk.

Figure 5.

Bronchial artery chemoembolization in a 65-year-old woman with metastatic colon cancer. (A) Bronchial angiogram shows hypervascular lung metastases. (B) After chemoembolization using lipiodol/mitomycin emulsion, noncontrast CT shows dense lipiodol retention in the lung metastases. Follow-up scan showed decreased size and metabolic activity of the treated tumors. Abbreviation: CT, computed tomography.