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.

Transarterial Treatment of Lung Cancer

“…However, it did not become a standard treatment method due to its complexity and uncertain drug distribution to the target lesions [ 5 ]. Recent advances in MDCT technology and 3D imaging together with the advent of spherical embolic material and microcatheter have made the transarterial treatment an alternative treatment for advanced lung cancer [ 1 , 6 , 9 , 10 ], and serious side effects are less likely to occur. In our present study, we demonstrated remarkable technical success without major complications or treatment-related mortality.…”

“…Overflow of embolic materials to the intercostal artery should be avoided. Analysis of angiographic images in combination with angio-CT is indispensable [ 6 ]. In our experience, there were no cases of neurological symptoms or complications even when the drugs were administrated into the intercostal artery.…”

“…Vascular shunts from the bronchial artery to the pulmonary artery or pulmonary vein may be observed in the periphery of the lungs [ 12 ]. If a shunt to the pulmonary vein is suspected, embolization should not be performed to avoid systemic embolization [ 6 ].…”

“…To obtain a good local effect, it is necessary to allocate the amount of drugs to be injected according to the blood supply ratio [ 6 , 13 ]. In the present study, most patients were systemic chemotherapy-refractory, and the chemotherapeutic drugs selected were based on patients’ prior treatment.…”

“…Lung cancer treatment via the bronchial artery has a long history [ 2 , 3 , 4 ], but has long been neglected due to technical difficulties and advances in other lung cancer treatments [ 5 ]. However, recent advances in diagnostic imaging, catheter technology, and arterial embolization materials have led to significant advances in transarterial treatment, which can now be utilized for treatment via bronchial arteries [ 6 ].…”