Embolization of Chest Neoplasms: The Next Frontier in Interventional Oncology?

Abstract

The management of chest tumors and their sequelae has been an uncommon indication for transarterial embolization (TAE). More recently, vascular embolization has been increasingly performed for this indication. The most common reported indication for embolization of neoplastic disease in the chest is the control of bleeding resulting either from iatrogenic causes or from tumor invasion into a bronchus or vessel.A natural extension of the application of TAE to neoplasm-related hemoptysis is its burgeoning indication as a possible primary treatment for benign chest tumors, primary lung neoplasms, and metastatic disease in patients that are refractory to systemic therapies and have limited or no surgical options. The goals for this indication are tumor regression and management of bulk-related symptoms. In addition to bland TAE for this indication, authors have reported very initial results applying transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) to chest neoplasms with promising results that support feasibility and safety. This article is an up-to-date review of the management of chest tumors with embolization and its variants.

Transarterial management of advance lung cancer

“…The clinical success rate, which means cessation of hemoptysis, was higher than 80% ( 17 , 20 , 23 ). Nevertheless, mortality resulting from hemoptysis and recurrence rate is high among these patients secondary to progression of lung cancer ( 21 , 24 ). On the other hand, prolongation of survival time by bronchial embolization was attributed to cessation of hemoptysis.…”

“…Shunting into pulmonary artery or vein is commonly found ( 6 ). Embolization therapy should be avoided in the case of early filling to pulmonary vein in angiography ( 17 , 24 ). Arterial infusion CT is much reliable in evaluating the vascular supply to the tumors.…”

“…Arterial infusion CT is much reliable in evaluating the vascular supply to the tumors. It is very common to find good enhancement on CT even if angiography did not show enhancement of tumors ( 24 ).…”

Pulmonary artery coil embolisation prevented tumour progression in a patient with advanced squamous cell lung carcinoma

“…Upon review of the literature, we were unable to find any similar cases attributing primary lung cancer regression to endovascular embolisation of tumour-feeding arteries. To our knowledge, only metastatic pulmonary lesions from primary renal cell carcinoma as well as some benign thoracic tumours have been reported to regress following transarterial embolisation ( 21 ). Furthermore, the disappearance of our patient’s metastatic lesion in the liver is also obscure.…”

“…The first-line treatment with cisplatin and gemcitabine appeared to be rather effective in reducing the primary tumour size. However, the initiation of chemotherapy coincided with the endovascular embolisation procedure, which could have also led to tumour volume reduction ( 21 ). Even if the initial radiological improvement can be attributed to systemic treatment, according to the literature, the chemotherapy regimens used for treating our patient are highly unlikely to induce a long-term remission.…”