Intravascular Treatment Techniques for Locoregional Therapies of Lung Tumors

Abstract

Background Lung cancer incidence has greatly increased over the past century. Moreover, the lung is the most common site of metastatic involvement. Despite improvements in the diagnosis and treatment of lung malignancies, patient prognosis is still unsatisfactory. Locoregional chemotherapeutic techniques for the treatment of lung malignancies are the current focus of research. The aim of this review article is to present different locoregional intravascular techniques and their treatment principles and to assess the pros and cons of each of them as a palliative and neoadjuvant treatment method in the treatment of lung malignancy.

Method The different methods for the treatment of malignant lung lesions such as isolated lung perfusion (ILP), selective pulmonary artery perfusion (SPAP), transpulmonary chemoembolization (TPCE), bronchial artery infusion (BAI), bronchioarterial chemoembolization (BACE), and intraarteriel chemoperfusion (IACP) are evaluated comparatively.

Results Locoregional intravascular chemotherapy procedures are proving to be promising treatment options in the management of malignant lung tumors. In order to achieve optimal results, the locoregional technique should be used to achieve the highest possible uptake of the chemotherapeutic agent into the target tissue with rapid systemic clearance.

Conclusion Among the various treatment options for lung malignancies, TPCE is the best evaluated treatment concept. However, further studies are necessary to define the optimal treatment concept with the best clinical outcomes.

Key Points 

• There are various intravascular chemotherapy methods for the treatment of lung malignancies.

• Transpulmonary chemoembolization (TPCE) is currently the most extensively evaluated treatment method for lung malignancies.

• Thermoablation after neoadjuvant chemoperfusion is a promising therapy for treating lung malignancies.

Citation Format

• Vogl TJ, Mekkawy A, Thabet DB. Intravascular Treatment Techniques for Locoregional Therapies of Lung Tumors. Fortschr Röntgenstr 2023; 195: 579 – 585

Key words

chemoembolization - interventional procedures - pulmonary metastases - lung cancer - locoregional techniques

Publikationsverlauf

Eingereicht: 06. Januar 2022

Angenommen: 04. Dezember 2022

Artikel online veröffentlicht:
02. März 2023

• References

• 1 Duma N, Santana-Davila R, Molina JR. Non-Small Cell Lung Cancer: Epidemiology, Screening, Diagnosis, and Treatment. Mayo Clin Proc 2019; 94 (08) 1623-1640
• 2 Rau B, Roth C, Schnider A. et al. Chirurgie der Lungenmetastasen extrapulmonaler Primärtumoren. Schweiz Med Forum 2002; 49: 1166-1170
• 3 Branscheid D, Krysa S, Stoelben E. et al. Chirurgische Therapie von Lungenmetastasen beim Nierenzellkarzinom – Diagnostik, Strategie, Ergebnisse. Akt Urol 1992; 23: 107-112
• 4 David EA, Andersen SW, Beckett LA. et al. Survival benefits associated with surgery for advanced non-small cell lung cancer. The Journal of Thoracic and Cardiovascular Surgery 2019; 157 (04) 1620-1628
• 5 Lemjabbar-Alaoui H, Hassan OU, Yang Y-W. et al. Lung cancer: Biology and treatment options. Biochim Biophys Acta 2015; 1856: 189-210
• 6 Minchinton AI, Tannock IF. Drug penetration in solid tumours. Nature Reviews Cancer 2006; 6: 583-592
• 7 Mentzer SJ, Antman KH, Attinger C. et al. Selected benefits of thoracotomy and chemotherapy for sarcoma metastatic to the lung. Journal of Surgical Oncology 1993; 53: 54-59
• 8 Genestreti G, Grossi F, Genova C. et al. Third- and further-line therapy in advanced non-small-cell lung cancer patients: an overview. Future Oncology 2014; 10: 2081-2096
• 9 Ren K, Wang J, Li Y. et al. The Efficacy of Drug-eluting Bead Transarterial Chemoembolization Loaded With Oxaliplatin for the Treatment of Stage III-IV Non-small-cell Lung Cancer. Acad Radiol 2022; 14 S1076-6332(22)00065-4
• 10 Vogl TJ, Shafinaderi M, Zangos S. et al. Regional chemotherapy of the lung: transpulmonary chemoembolization in malignant lung tumors. Semin Interven Radiol 2013; 30: 176-184
• 11 Boas FE, Kemeny NE, Sofocleous CT. et al. Bronchial or Pulmonary Artery Chemoembolization for Unresectable and Unablatable Lung Metastases: A Phase I Clinical Trial. Radiology 2021; 301 (02) 474-484
• 12 Vogl TJ, Nour-Eldin NA, Albrecht MH. et al. Thermal Ablation of Lung Tumors: Focus on Microwave Ablation. Fortschr Röntgenstr 2017; 189 (09) 828-843
• 13 van Putte BP, Hendriks JM, Romijn S. et al. Isolated lung perfusion for the treatment of pulmonary metastases current mini-review of work in progress. Surgical Oncology 2003; 12: 187-193
• 14 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: 1542-1549
• 15 Urano M. Invited Review: For the clinical application of thermo-chemotherapy given at mild temperatures. International Journal of Hyperthermia 1999; 15: 79-107
• 16 Muller H, Hilger R. Curative and palliative aspects of regional chemotherapy in combination with surgery. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer 2003; 11: 1-10
• 17 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: 893-898
• 18 Demmy TL, Wagner-Mann C, Allen A. Isolated lung chemotherapeutic infusions for treatment of pulmonary metastases: a pilot study. Journal of Biomedical Science 2002; 9: 334-338
• 19 Mallick R, Demmy T. Regional lung chemotherapy techniques. Innovations 2011; 6: 1-9
• 20 van Putte BP, Grootenboers M, van Boven WJ. et al. Selective pulmonary artery perfusion for the treatment of primary lung cancer: Improved drug exposure of the lung. Lung Cancer 2009; 65: 208-213
• 21 Den HengstWA, Hendriks JMH, Van Hoof T. et al. Selective pulmonary artery perfusion with melphalan is equal to isolated lung perfusion but superior to intravenous melphalan for the treatment of sarcoma lung metastases in a rodent model†. European Journal of Cardio-Thoracic Surgery 2012; 42: 341-347
• 22 Weksler B, Ng B, Lenert JT. et al. Isolated single-lung perfusion with doxorubicin is pharmacokinetically superior to intravenous injection. Ann Thorac Surg 1993; 56: 209-214
• 23 Lindemayr S, Lehnert T, Korkusuz H. et al. Transpulmonary chemoembolization: a novel approach for the treatment of unresectable lung tumors. Techniques in Vascular and Interventional Radiology 2007; 10: 114-119
• 24 Huppert PE, Geißler F, Duda SH. et al. Chemoembolisation des hepatozellulären Karzinoms: Computertomographische Befunde und klinische Resultate bei prospektiv repetitiver Therapie. Fortschr Röntgenstr 1994; 160: 425-432
• 25 Vogl TJ, Mekkawy AIA, Thabet DB. et al. Transvenous pulmonary chemoembolization (TPCE) for palliative or neoadjuvant treatment of lung metastases. European Radiology 2019; 29: 1939-1949
• 26 Schneider P, Kampfer S, Loddenkemper C. et al. Chemoembolization of the lung improves tumor control in a rat model. Clin Cancer Res 2002; 8: 2463-2468
• 27 Golder WA. Chemoembolisation der Lunge. Der Onkologe 2008; 14: 934-939
• 28 Nguyen-Kim TD, Frauenfelder T, Strobel K. et al. Assessment of bronchial and pulmonary blood supply in non-small cell lung cancer subtypes using computed tomography perfusion. Investigative Radiology 2015; 50: 179-186
• 29 Gadaleta CD, Solbiati L, Mattioli V. et al. Unresectable lung malignancy: combination therapy with segmental pulmonary arterial chemoembolization with drug-eluting microspheres and radiofrequency ablation in 17 patients. Radiology 2013; 267: 627-637
• 30 Lewis AL, Gonzalez MV, Lloyd AW. et al. DC bead: in vitro characterization of a drug-delivery device for transarterial chemoembolization. Journal of Vascular and Interventional Radiology: JVIR 2006; 17: 335-342
• 31 Kitai T, Nomura A, Miki A. et al. [Clinical benefit of bronchial arterial infusion chemotherapy to pulmonary metastasis from colorectal cancer--report of two cases]. Gan to kagaku ryoho Cancer & Chemotherapy 2003; 30: 2125-2128
• 32 Kahn PC, Paul RE, Rheinlander HF. Selective bronchial arteriography and intra-arterial chemotherapy in carcinoma of the lung. Journal of Thoracic and Cardiovascular Surgery 1965; 50: 640-645
• 33 Jiang GM, Zhao JW, Chen YX. et al. [Blood supply of pulmonary metastases and its clinical significance]. Chinese Journal of Cancer 2006; 25: 885-887
• 34 Sheng S, Zheng J, Cui S. et al. Complete remission of multiple lung metastases after ablation of hepatocellular carcinoma by transarterial infusion with the p53 gene. Anti-cancer Drugs 2015; 26: 227-231
• 35 Kaseda S, Shimizu K, Yamane T. et al. Bronchial arterial infusion with cisplatin followed by irradiation successfully treats recurrent stage IVb thymic large cell carcinoma. European journal of Cardio-thoracic Surgery 1999; 16: 471-474
• 36 Koshiishi H, Utsumi K, Tamamoto F. et al. [Evaluation of bronchial arterial infusion (BAI) for high risk lung cancer]. Gan To Kagaku Ryoho 2000; 27: 1907-1910
• 37 Freckman HA, Mendez Jr FL, Maurer ER. et al. Chemotherapy for lung cancer by intra-aortic infusion. Jama 1966; 196: 5-10
• 38 YOSHIKAWA K. Ten Years' Experience With Intra-Aortic Infusion Chemotherapy for Gastrointestinal Malignant Tumors. Japanese Journal of Clinical Oncology 1981; 11: 391-398
• 39 Collins JM. Pharmacologic rationale for regional drug delivery. Journal of Clinical Oncology 1984; 2: 498-504
• 40 Takeda N, Diksic M. Relationship between drug delivery and the intra-arterial infusion rate of SarCNU in C6 rat brain tumor model. Journal of Neuro-oncology 1999; 41: 235-246
• 41 Vogl TJ, Lindemayr S, Naguib NN. et al. Nonselective transarterial chemoperfusion: a palliative treatment for malignant pleural mesothelioma. Radiology 2013; 266: 649-656
• 42 Dempsey PJ, Ridge CA, Solomon SB. Advances in Interventional Oncology: Lung Cancer Cancer. J 2016; 22 (06) 393-400
• 43 Ponder E. The Coefficient of Thermal Conductivity of Blood and of Various Tissues. Journal of General Physiology 1962; 45: 545-551
• 44 Safavi AH, Mak DY, Boldt RG. et al. Stereotactic ablative radiotherapy in T1-2N0M0 small cell lung cancer: A systematic review and meta-analysis. Lung Cancer 2021; 160: 179-186
• 45 Hohenforst-Schmidt W, Zarogoulidis P, Stopek J. et al. DDMC-p53 gene therapy with or without cisplatin and microwave ablation. OncoTargets and Therapy 2015; 8: 1165-1173
• 46 Lee JM, Youk JH, Kim YK. et al. Radio-frequency thermal ablation with hypertonic saline solution injection of the lung: ex vivo and in vivo feasibility studies. European Radiology 2003; 13: 2540-2547
• 47 Oshima F, Yamakado K, Akeboshi M. et al. Lung radiofrequency ablation with and without bronchial occlusion: experimental study in porcine lungs. Journal of Vascular and Interventional Radiology: JVIR 2004; 15: 1451-1456
• 48 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. Oncology Reports 2005; 14: 1571-1576
• 49 Dupuy DE, DiPetrillo T, Gandhi S. et al. Radiofrequency ablation followed by conventional radiotherapy for medically inoperable stage I non-small cell lung cancer. Chest 2006; 129: 738-745
• 50 Zeng Y, Yin M, Zhao Y. et al. Combination of Bronchial Arterial Infusion Chemotherapy plus Drug-Eluting Embolic Transarterial Chemoembolization for Treatment of Advanced Lung Cancer-A Retrospective Analysis of 23 Patients. J Vasc Interv Radiol 2020; 31 (10) 1645-1653