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European Radiology

, Volume 29, Issue 4, pp 1939–1949 | Cite as

Transvenous pulmonary chemoembolization (TPCE) for palliative or neoadjuvant treatment of lung metastases

  • Thomas J. Vogl
  • Ahmed I. A. MekkawyEmail author
  • Duaa B. Thabet
  • Mostafa El-Sharkaway
  • Hosam M. Kamel
  • Moritz H. Albrecht
  • Nagy N. N. Naguib
  • Afaf Hassan
Interventional
  • 107 Downloads

Abstract

Purpose

To retrospectively evaluate tumor response, local tumor control, and patient survival after the treatment of pulmonary metastases using transpulmonary chemoembolization (TPCE) in palliative and neoadjuvant intent.

Materials and methods

One hundred forty-three patients (mean age 56.7 ± 13.4 years) underwent repetitive TPCE (mean number of sessions 5.8 ± 2.9) between June 2005 and April 2017 for the treatment of unresectable lung metastases, not responding to systemic chemotherapy. Patients had predominant lung metastases with bilateral lung involvement in 80.4% of the cases. Regional delivery of the chemotherapeutic agents was performed through selective catheterization of the tumor-supplying pulmonary arteries with subsequent injection of iodized oil and microspheres. Patients, who underwent subsequent ablation (n = 51), either for all lesions (complete) or dominant lesions (incomplete), constituted the neoadjuvant group, and those who underwent TPCE alone represented the palliative treatment intent (n = 92). The response was assessed according to the revised Response Evaluation Criteria in Solid Tumors (RECIST).

Results

Partial response was achieved in 11.9% (n = 17), stable disease in 66.4% (n = 95), and progressive disease in 21.7% (n = 31). The mean survival time and time to progression were 24.5 ± 1.7 and 7.5 ± 0.5 months, respectively. The mean survival time was shorter for the palliative group (19.7 ± 2), compared to the neoadjuvant group (30.1 ± 2.6 months). The use of TPCE alone or with incomplete ablation had a significantly increased hazard of death of 4.6- (p = 0.002) and 3.1-fold (p = 0.027), respectively, in comparison with TPCE with subsequent complete ablation.

Conclusion

TPCE has the potential to improve local tumor control and to prolong survival with a neoadjuvant potential when combined with ablation therapy.

Key Points

Transpulmonary chemoembolization (TPCE) is a locoregional technique for delivering chemotherapy in higher intratumoral concentrations and with reduced systemic toxicity.

TPCE can be an alternative treatment for patients with pulmonary metastases who failed prior systemic chemotherapy or with post-operative recurrence.

The current retrospective study revealed that TPCE is a feasible treatment option for patients with unrespectable lung secondaries in both palliative and neoadjuvant intent and has the potential of improving local control and prolonging survival.

Keywords

Therapeutic chemoembolization Lung neoplasms Interventional radiology Palliative care Neoadjuvant therapy 

Abbreviations

Angio-CT

Computed tomography angiography

CT

Computed tomography

HR

Hazard ratio

ILP

Isolated lung perfusion

MDCT

Multidetector computed tomography

MRI

Magnetic resonance imaging

PD

Progressive disease

PR

Partial response

RECIST

Response Evaluation Criteria in Solid Tumors

SD

Stable disease

TPCE

Transpulmonary chemoembolization

TTP

Mean time to progression

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Prof. Dr. Thomas J. Vogl, Department of Diagnostic and Interventional Radiology, Goethe-University, Frankfurt/Main.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because of its retrospective nature.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

References

  1. 1.
    Van Meerbeeck JP, Gosselin R, Duyck P (2007) Lung metastases: epidemiology, clinical presentation and imaging. In: Van Schil P (ed) Lung metastases and isolated lung perfusion. Nova Science Publishers, Inc, HauppaugeGoogle Scholar
  2. 2.
    Mohammed TL, Chowdhry A, Reddy GP et al (2011) ACR Appropriateness Criteria(R) screening for pulmonary metastases. J Thorac Imaging 26:W1–W3CrossRefGoogle Scholar
  3. 3.
    Fan J, Chen D, Du H, Shen C, Che G (2015) Prognostic factors for resection of isolated pulmonary metastases in breast cancer patients: a systematic review and meta-analysis. J Thorac Dis 7:1441–1451Google Scholar
  4. 4.
    Friedel G, Pastorino U, Buyse M et al (1999) Resection of lung metastases: long-term results and prognostic analysis based on 5206 cases--the International Registry of Lung Metastases. Zentralbl Chir 124:96–103Google Scholar
  5. 5.
    Van Raemdonck D (2015) Pulmonary metastasectomy: common practice but is it also best practice? Future Oncol 11:11–14CrossRefGoogle Scholar
  6. 6.
    Edwards MS, Chadda SD, Zhao Z, Barber BL, Sykes DP (2012) A systematic review of treatment guidelines for metastatic colorectal cancer. Colorectal Dis 14:e31–e47CrossRefGoogle Scholar
  7. 7.
    Dawood S, Broglio K, Ensor J, Hortobagyi GN, Giordano SH (2010) Survival differences among women with de novo stage IV and relapsed breast cancer. Ann Oncol 21:2169–2174CrossRefGoogle Scholar
  8. 8.
    Tonini G, Imperatori M, Vincenzi B, Frezza AM, Santini D (2013) Rechallenge therapy and treatment holiday: different strategies in management of metastatic colorectal cancer. J Exp Clin Cancer Res 32:92CrossRefGoogle Scholar
  9. 9.
    Van Schil PE (2002) Surgical treatment for pulmonary metastases. Acta Clin Belg 57:333–339CrossRefGoogle Scholar
  10. 10.
    Minchinton AI, Tannock IF (2006) Drug penetration in solid tumours. Nat Rev Cancer 6:583–592CrossRefGoogle Scholar
  11. 11.
    Jiang GM, Zhao JW, Chen YX, Tian F (2006) Blood supply of pulmonary metastases and its clinical significance. Ai Zheng 25:885–887Google Scholar
  12. 12.
    Hendriks JM, Romijn S, Van Putte B, Stockman B, ten Broecke P, Van Schil P (2005) Isolated lung perfusion for the treatment of pulmonary metastatic disease: a review. Acta Chir Belg 105:338–343CrossRefGoogle Scholar
  13. 13.
    Weksler B, Ng B, Lenert JT, Burt ME (1993) Isolated single-lung perfusion with doxorubicin is pharmacokinetically superior to intravenous injection. Ann Thorac Surg 56:209–214CrossRefGoogle Scholar
  14. 14.
    Vogl TJ, Trapp M, Schroeder H et al (2000) Transarterial chemoembolization for hepatocellular carcinoma: volumetric and morphologic CT criteria for assessment of prognosis and therapeutic success-results from a liver transplantation center. Radiology 214:349–357CrossRefGoogle Scholar
  15. 15.
    Schneider P, Kampfer S, Loddenkemper C, Foitzik T, Buhr HJ (2002) Chemoembolization of the lung improves tumor control in a rat model. Clin Cancer Res 8:2463–2468Google Scholar
  16. 16.
    Milne EN, Zerhouni EA (1987) Blood supply of pulmonary metastases. J Thorac Imaging 2:15–23CrossRefGoogle Scholar
  17. 17.
    Pohlen U, Rieger H, Meyer BT et al (2007) Chemoembolization of lung metastases--pharmacokinetic behaviour of carboplatin in a rat model. Anticancer Res 27:809–815Google Scholar
  18. 18.
    Lindemayr S, Lehnert T, Korkusuz H, Hammerstingl R, Vogl TJ (2007) Transpulmonary chemoembolization: a novel approach for the treatment of unresectable lung tumors. Tech Vasc Interv Radiol 10:114–119CrossRefGoogle Scholar
  19. 19.
    Vogl TJ, Shafinaderi M, Zangos S, Lindemayr S, Vatankhah K (2013) Regional chemotherapy of the lung: transpulmonary chemoembolization in malignant lung tumors. Semin Intervent Radiol 30:176–184CrossRefGoogle Scholar
  20. 20.
    Kluger MD, Halazun KJ, Barroso RT et al (2014) Bland embolization versus chemoembolization of hepatocellular carcinoma before transplantation. Liver Transpl 20:536–543CrossRefGoogle Scholar
  21. 21.
    Vogl TJ, Wetter A, Lindemayr S, Zangos S (2005) Treatment of unresectable lung metastases with transpulmonary chemoembolization: preliminary experience. Radiology 234:917–922CrossRefGoogle Scholar
  22. 22.
    Vogl TJ, Lehnert T, Zangos S et al (2008) Transpulmonary chemoembolization (TPCE) as a treatment for unresectable lung metastases. Eur Radiol 18:2449–2455CrossRefGoogle Scholar
  23. 23.
    Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247CrossRefGoogle Scholar
  24. 24.
    Gadaleta CD, Solbiati L, Mattioli V et al (2013) Unresectable lung malignancy: combination therapy with segmental pulmonary arterial chemoembolization with drug-eluting microspheres and radiofrequency ablation in 17 patients. Radiology 267:627–637CrossRefGoogle Scholar
  25. 25.
    Tait CR, Dodwell D, Horgan K (2004) Do metastases metastasize? J Pathol 203:515–518CrossRefGoogle Scholar
  26. 26.
    Oxnard GR, Morris MJ, Hodi FS et al (2012) When progressive disease does not mean treatment failure: reconsidering the criteria for progression. J Natl Cancer Inst 104:1534–1541CrossRefGoogle Scholar
  27. 27.
    Leung AM, Hari DM, Morton DL (2012) Surgery for distant melanoma metastasis. Cancer J 18:176–184CrossRefGoogle Scholar
  28. 28.
    Locati LD, Guzzo M, Bossi P et al (2005) Lung metastasectomy in adenoid cystic carcinoma (ACC) of salivary gland. Oral Oncol 41:890–894CrossRefGoogle Scholar
  29. 29.
    Treasure T, Fiorentino F, Scarci M, Moller H, Utley M (2012) Pulmonary metastasectomy for sarcoma: a systematic review of reported outcomes in the context of Thames Cancer Registry data. BMJ Open 2.  https://doi.org/10.1136/bmjopen-2012-001736
  30. 30.
    Nakamura T, Matsumine A, Yamakado K et al (2009) Lung radiofrequency ablation in patients with pulmonary metastases from musculoskeletal sarcomas [corrected]. Cancer 115:3774–3781CrossRefGoogle Scholar
  31. 31.
    Hawkes EA, Ladas G, Cunningham D et al (2012) Peri-operative chemotherapy in the management of resectable colorectal cancer pulmonary metastases. BMC Cancer 12:326CrossRefGoogle Scholar
  32. 32.
    Younes RN, Gross JL, Taira AM, Martins AA, Neves GS (2009) Surgical resection of lung metastases: results from 529 patients. Clinics (Sao Paulo) 64:535–541CrossRefGoogle Scholar
  33. 33.
    Inoue Y, Miki C, Hiro J et al (2005) Improved survival using multi-modality therapy in patients with lung metastases from colorectal cancer: a preliminary study. Oncol Rep 14:1571–1576Google Scholar
  34. 34.
    Wei Z, Ye X, Yang X et al (2015) Microwave ablation plus chemotherapy improved progression-free survival of advanced non-small cell lung cancer compared to chemotherapy alone. Med Oncol 32:464CrossRefGoogle Scholar
  35. 35.
    Welter S, Arfanis E, Christoph D et al (2017) Growth patterns of pulmonary metastases: should we adjust resection techniques to primary histology and size? Eur J Cardiothorac Surg.  https://doi.org/10.1093/ejcts/ezx063
  36. 36.
    Akhan O, Güler E, Akýncý D, Çiftçi T, Köse IÇ (2016) Radiofrequency ablation for lung tumors: outcomes, effects on survival, and prognostic factors. Diagn Interv Radiol 22:65–71Google Scholar
  37. 37.
    Pfannschmidt J, Egerer G, Bischof M, Thomas M, Dienemann H (2012) Surgical intervention for pulmonary metastases. Dtsch Arztebl Int 109:652–658Google Scholar
  38. 38.
    Inderbitzi R, Rolle A (2001) Palliative surgery for primary and secondary thoracic malignancies. Ther Umsch 58:435–441CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Institute of Diagnostic and Interventional RadiologyUniversity Hospital Frankfurt, Johann Wolfgang Goethe University FrankfurtFrankfurt am MainGermany
  2. 2.Department of Diagnostic Radiology, South Egypt Cancer InstituteAssiut UniversityAsyutEgypt
  3. 3.Department of Chest Disease, Faculty of MedicineAssiut UniversityAsyutEgypt
  4. 4.Department of Diagnostic and Interventional RadiologyAlexandria UniversityAlexandriaEgypt
  5. 5.Department of Diagnostic Radiology, Faculty of MedicineAssiut UniversityAsyutEgypt

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