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



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).


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.


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.


Therapeutic chemoembolization Lung neoplasms Interventional radiology Palliative care Neoadjuvant therapy 



Computed tomography angiography


Computed tomography


Hazard ratio


Isolated lung perfusion


Multidetector computed tomography


Magnetic resonance imaging


Progressive disease


Partial response


Response Evaluation Criteria in Solid Tumors


Stable disease


Transpulmonary chemoembolization


Mean time to progression



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

Compliance with ethical standards


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.


• Retrospective

• Observational

• Performed at one institution


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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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