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.
An 82-year-old man underwent transarterial chemoembolization and radiofrequency ablation (RFA) for a 42-mm hepatocellular carcinoma in segment IV. Thirty-eight months later, he was admitted to our hospital for acute cholecystitis that had spread to the ablated area. After he started antibiotic treatment, the inflammatory reaction gradually improved, but he developed acute cholangitis, and massive hemobilia was observed during endoscopic retrograde biliary drainage. An angiogram showed both a pseudoaneurysm of the left hepatic artery (LHA) and extravasation of the microcatheter into a marginal lesion of the ablated area. The pseudoaneurysm was considered to have been formed by inflammation that perforated the ablated area and intrahepatic bile duct. After embolization of the LHA, no further bleeding was observed. A pseudoaneurysm may develop from an infection, even several years after liver RFA.
Purpose: The treatment efficacy of the transarterial approach to lung cancer is evaluated. Materials and Methods: A total of 98 patients with advanced lung cancer or recurrent lung cancer after the standard therapies were enrolled retrospectively. The bronchial arteries and mediastinal branches from the subclavian artery were selected by a microcatheter. Immediately after the selective arterial infusion of anti-neoplastic agents, embolization with a spherical embolic material was carried out. Local tumor effects and overall survival were evaluated. Result: The mean reduction rate was 17.9%, with 24.2% for partial remission and with 2.1% for progression disease. The rate of stable disease was 72.6%. The response rate was 25.3%, and the disease control rate was 97.9%. The median survival time (MST) was 11.4 months, the 1-year survival rate was 45.2%, and the 2-year survival rate was 35.6%. Although it is insignificant, the MST for 51 adenocarcinomas was higher than that of 29 squamous cell carcinomas (18.6 months and 9.4 months, respectively). The local extension of tumors related to a better prognosis, though it was not significant. Lymph node metastases and distant metastases were poor prognostic factors. No major complications nor treatment-related mortalities were found in this study. Conclusion: The transarterial treatment for lung cancer should be considered as a treatment option when the other treatments were not indicated both in initial cases and in recurrent cases.
Proton beam therapy is a type of radiation therapy and a promising modality for cancer management because it involves few adverse effects and high therapeutic efficacy. However, there are reports of acute and late complications because of normal tissue damage. Hemobilia, known as bleeding from the biliary tree, is observed in various conditions, and it can also be of iatrogenic origin such as due to percutaneous hepatobiliary interventions. In most cases, it can be managed conservatively without significant hemorrhage. However, in a few cases with massive hemobilia, further intervention is necessary. We report the successful use of a stent-graft in the portal vein to treat massive hemobilia with porto-biliary fistula that was caused by previous proton beam therapy.
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