Semin intervent Radiol 2013; 30(02): 176-184
DOI: 10.1055/s-0033-1342959
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Regional Chemotherapy of the Lung: Transpulmonary Chemoembolization in Malignant Lung Tumors

Thomas J. Vogl
1   Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
,
Mohammad Shafinaderi
1   Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
,
Stefan Zangos
1   Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
,
Sebastian Lindemayr
1   Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
,
Khashayar Vatankhah
1   Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
28 May 2013 (online)

Abstract

Standard treatment options in patients with lung cancer and pulmonary metastases are surgery, radiotherapy, chemotherapy, and immunotherapy. For reducing clinical complications of surgery and achieving a better local response, transpulmonary chemoembolization of the lungs is a possible interventional technique in which anticancer drugs are administered directly into a tumor through its feeding vessels followed by occlusive agents that are injected through the delivery catheter for blocking the vessel. This allows a longer contact period in the tumor with a higher cytostatic drug concentration. The technique is safe and results present promising local response rates, but the influence on survival is still questionable. This article describes the current role of intravascular therapies in the treatment of pulmonary malignancies.

 
  • References

  • 1 Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005; 55 (2) 74-108
  • 2 Thun MJ, Henley SJ, Calle EE. Tobacco use and cancer: an epidemiologic perspective for geneticists. Oncogene 2002; 21 (48) 7307-7325
  • 3 Hughes JMB, Morrell NW. Pulmonary Circulation: From Basic Mechanisms to Clinical Practice. London, United Kingdom: Imperial College Press; 2001. :xix, 356
  • 4 Carden DL, Matthay MA, George RB. Chest Medicine: Essentials of Pulmonary and Critical Care Medicine. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005. :xvii, 652
  • 5 Riquet M. Bronchial arteries and lymphatics of the lung. Thorac Surg Clin 2007; 17 (4) 619-638 , viii
  • 6 Schiller JH, Harrington D, Belani CP , et al; Eastern Cooperative Oncology Group. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med 2002; 346 (2) 92-98
  • 7 Minchinton AI, Tannock IF. Drug penetration in solid tumours. Nat Rev Cancer 2006; 6 (8) 583-592
  • 8 Gonsalves CF, Brown DB. Chemoembolization of hepatic malignancy. Abdom Imaging 2009; 34 (5) 557-565
  • 9 Golder WA. Chemoembolization of the lungs: basic anatomical elements, experimental results, clinical experience. Onkologe 2008; 14: 934-939
  • 10 Lindemayr S, Lehnert T, Korkusuz H, Hammerstingl R, Vogl TJ. Transpulmonary chemoembolization: a novel approach for the treatment of unresectable lung tumors. Tech Vasc Interv Radiol 2007; 10 (2) 114-119
  • 11 Lewis AL, Gonzalez MV, Lloyd AW , et al. DC bead: in vitro characterization of a drug-delivery device for transarterial chemoembolization. J Vasc Interv Radiol 2006; 17 (2 Pt 1) 335-342
  • 12 Vogl TJ, Wetter A, Lindemayr S, Zangos S. Treatment of unresectable lung metastases with transpulmonary chemoembolization: preliminary experience. Radiology 2005; 234 (3) 917-922
  • 13 Jiang GM, Zhao JW, Chen YX, Tian F. Blood supply of pulmonary metastases and its clinical significance [in Chinese]. Ai Zheng 2006; 25 (7) 885-887
  • 14 Kahn PC, Paul RE, Rheinlander HF. Selective bronchial arteriography and intra-arterial chemotherapy in carcinoma of the lung. J Thorac Cardiovasc Surg 1965; 50 (5) 640-645
  • 15 Hellekant C, Jonsson K. Double blood supply of bronchogenic carcinoma from multiple arteries. Acta Radiol Diagn (Stockh) 1981; 22 (4) 403-406
  • 16 Nakanishi M, Umeda Y, Demura Y , et al. Effective use of multi-arterial infusion chemotherapy for advanced non-small cell lung cancer patients: four clinical specified cases. Lung Cancer 2007; 55 (2) 241-247
  • 17 Nakanishi M, Demura Y, Umeda Y , et al. Multi-arterial infusion chemotherapy for non-small cell lung carcinoma—significance of detecting feeding arteries and tumor staining. Lung Cancer 2008; 61 (2) 227-234
  • 18 Mallick R, Demmy T. Regional lung chemotherapy techniques. Innovations (Phila) 2011; 6 (1) 1-9
  • 19 Urano M, Kuroda M, Nishimura Y. For the clinical application of thermochemotherapy given at mild temperatures. Int J Hyperthermia 1999; 15 (2) 79-107
  • 20 Demmy TL, Tomaszewski G, Dy GK , et al. Thoracoscopic organ suffusion for regional lung chemotherapy (preliminary results). Ann Thorac Surg 2009; 88 (2) 385-390 ; discussion 390–391
  • 21 Carpenter AJ, Follette DM, Sheppard B, Yoshikawa R, Sam J. Simultaneous antegrade and retrograde reperfusion after cardioplegic arrest for coronary artery bypass. J Card Surg 1999; 14 (5) 354-358
  • 22 Vogt-Moykopf I, Bulzebruck H, Kryza S, Kruschinski H, Branscheid D, Schirren J. Results in surgery of pulmonary metastases. Chirurgie 1992; 118 (5) 263-271
  • 23 Friedel G, Pastorino U, Buyse M , et al. [Resection of lung metastases: long-term results and prognostic analysis based on 5206 cases—the International Registry of Lung Metastases [in German]. Zentralbl Chir 1999; 124 (2) 96-103
  • 24 Hendriks JM, Romijn S, Van Putte B , et al. Long-term results of surgical resection of lung metastases. Acta Chir Belg 2001; 101 (6) 267-272
  • 25 Abecasis N, Cortez F, Bettencourt A, Costa CS, Orvalho F, de Almeida JM. Surgical treatment of lung metastases: prognostic factors for long-term survival. J Surg Oncol 1999; 72 (4) 193-198
  • 26 Lanza LA, Putnam Jr JB, Benjamin RS, Roth JA. Response to chemotherapy does not predict survival after resection of sarcomatous pulmonary metastases. Ann Thorac Surg 1991; 51 (2) 219-224
  • 27 Casson AG, Putnam JB, Natarajan G , et al. Five-year survival after pulmonary metastasectomy for adult soft tissue sarcoma. Cancer 1992; 69 (3) 662-668
  • 28 Ueda T, Uchida A, Kodama K , et al. Aggressive pulmonary metastasectomy for soft tissue sarcomas. Cancer 1993; 72 (6) 1919-1925
  • 29 Weksler B, Ng B, Lenert JT, Burt ME. Isolated single-lung perfusion with doxorubicin is pharmacokinetically superior to intravenous injection. Ann Thorac Surg 1993; 56 (2) 209-214
  • 30 Mountain CF, Khalil KG, Hermes KE, Frazier OH. The contribution of surgery to the management of carcinomatous pulmonary metastases. Cancer 1978; 41 (3) 833-840
  • 31 Inoue Y, Miki C, Hiro J , et al. Improved survival using multi-modality therapy in patients with lung metastases from colorectal cancer: a preliminary study. Oncol Rep 2005; 14 (6) 1571-1576
  • 32 Van Putte BP, Hendriks JM, Romijn S , et al. Single-pass isolated lung perfusion versus recirculating isolated lung perfusion with melphalan in a rat model. Ann Thorac Surg 2002; 74 (3) 893-898 ; discussion 898
  • 33 Romijn S, Hendriks JM, Van Putte BP , et al. Regional differences of melphalan lung levels after isolated lung perfusion in the rat. J Surg Res 2005; 125 (2) 157-160
  • 34 Schneider P, Kampfer S, Loddenkemper C, Foitzik T, Buhr HJ. Chemoembolization of the lung improves tumor control in a rat model. Clin Cancer Res 2002; 8 (7) 2463-2468
  • 35 Wagner W, von Eiff M, Klinke F, Micke O, Rübe C, Willich N. [Neoadjuvant radiochemotherapy in locally advanced non-small cell bronchial carcinoma. Initial results of a prospective multicenter study [in German]. Strahlenther Onkol 1995; 171 (7) 390-397
  • 36 Lindemayr S, Lehnert T, Korkusuz H, Hammerstingl R, Vogl TJ. Transpulmonary chemoembolization: a novel approach for the treatment of unresectable lung tumors. Tech Vasc Interv Radiol 2007; 10 (2) 114-119
  • 37 Watanabe Y, Shimizu J, Murakami S , et al. Reappraisal of bronchial arterial infusion therapy for advanced lung cancer. Jpn J Surg 1990; 20 (1) 27-35
  • 38 Shi W, Zhang S, Zhang X. Treatment of non-small-cell lung cancer by dual (bronchial and pulmonary) arterial drug infusion [in Chinese]. Zhonghua Zhong Liu Za Zhi 1995; 17 (2) 146-148
  • 39 Ratto GB, Toma S, Civalleri D , et al. Isolated lung perfusion with platinum in the treatment of pulmonary metastases from soft tissue sarcomas. J Thorac Cardiovasc Surg 1996; 112 (3) 614-622
  • 40 So T, Osaki T, Nakata S, Hanagiri T, Sugio K, Yasumoto K. Carinal resection after induction bronchial arterial infusion for locally advanced non-small cell lung cancer. Jpn J Thorac Cardiovasc Surg 2004; 52 (3) 143-147
  • 41 Schneider P, Foitzik T, Pohlen U, Golder W, Buhr HJ. Temporary unilateral microembolization of the lung—a new approach to regional chemotherapy for pulmonary metastases. J Surg Res 2002; 107 (2) 159-166
  • 42 Osaki T, Hanagiri T, Nakanishi R, Yoshino I, Taga S, Yasumoto K. Bronchial arterial infusion is an effective therapeutic modality for centrally located early-stage lung cancer: results of a pilot study. Chest 1999; 115 (5) 1424-1428
  • 43 Burt ME, Liu D, Abolhoda A , et al. Isolated lung perfusion for patients with unresectable metastases from sarcoma: a phase I trial. Ann Thorac Surg 2000; 69 (5) 1542-1549
  • 44 Schröder C, Fisher S, Pieck AC , et al. Technique and results of hyperthermic (41 ° C) isolated lung perfusion with high-doses of cisplatin for the treatment of surgically relapsing or unresectable lung sarcoma metastasis. Eur J Cardiothorac Surg 2002; 22 (1) 41-46
  • 45 Karakousis CP, Park HC, Sharma SD, Kanter P. Regional chemotherapy via the pulmonary artery for pulmonary metastases. J Surg Oncol 1981; 18 (3) 249-255
  • 46 Liu CL, Wang YD, Jin XJ. Clinical observation on treatment of non-small cell lung cancer with Chinese herbal medicine combined with bronchial arterial infusion chemotherapy [in Chinese]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2001; 21 (8) 579-581
  • 47 Hendriks JM, Grootenboers MJ, Schramel FM , et al. Isolated lung perfusion with melphalan for resectable lung metastases: a phase I clinical trial. Ann Thorac Surg 2004; 78 (6) 1919-1926 ; discussion 1926–1927
  • 48 Koshiishi H, Utsumi K, Tamamoto F, Takahashi E. Evaluation of bronchial arterial infusion (BAI) for high risk lung cancer [in Japanese]. Gan To Kagaku Ryoho 2000; 27 (12) 1907-1910
  • 49 Johnston MR, Minchen RF, Dawson CA. Lung perfusion with chemotherapy in patients with unresectable metastatic sarcoma to the lung or diffuse bronchioloalveolar carcinoma. J Thorac Cardiovasc Surg 1995; 110 (2) 368-373
  • 50 Pass HI, Mew DJ, Kranda KC, Temeck BK, Donington JS, Rosenberg SA. Isolated lung perfusion with tumor necrosis factor for pulmonary metastases. Ann Thorac Surg 1996; 61 (6) 1609-1617
  • 51 Wang G, Song M, Xu H, Fang Y. Prospective trial of combined hyperfractionated radiotherapy and bronchial arterial infusion of chemotherapy for locally advanced nonsmall cell lung cancer. Int J Radiat Oncol Biol Phys 1996; 34 (2) 309-313