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.
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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
References
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, Hauppauge
Mohammed TL, Chowdhry A, Reddy GP et al (2011) ACR Appropriateness Criteria(R) screening for pulmonary metastases. J Thorac Imaging 26:W1–W3
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 7:1441–1451
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 124:96–103
Van Raemdonck D (2015) Pulmonary metastasectomy: common practice but is it also best practice? Future Oncol 11:11–14
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–e47
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 21:2169–2174
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 32:92
Van Schil PE (2002) Surgical treatment for pulmonary metastases. Acta Clin Belg 57:333–339
Minchinton AI, Tannock IF (2006) Drug penetration in solid tumours. Nat Rev Cancer 6:583–592
Jiang GM, Zhao JW, Chen YX, Tian F (2006) Blood supply of pulmonary metastases and its clinical significance. Ai Zheng 25:885–887
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 105:338–343
Weksler B, Ng B, Lenert JT, Burt ME (1993) Isolated single-lung perfusion with doxorubicin is pharmacokinetically superior to intravenous injection. Ann Thorac Surg 56:209–214
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 214:349–357
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 8:2463–2468
Milne EN, Zerhouni EA (1987) Blood supply of pulmonary metastases. J Thorac Imaging 2:15–23
Pohlen U, Rieger H, Meyer BT et al (2007) Chemoembolization of lung metastases--pharmacokinetic behaviour of carboplatin in a rat model. Anticancer Res 27:809–815
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 10:114–119
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 30:176–184
Kluger MD, Halazun KJ, Barroso RT et al (2014) Bland embolization versus chemoembolization of hepatocellular carcinoma before transplantation. Liver Transpl 20:536–543
Vogl TJ, Wetter A, Lindemayr S, Zangos S (2005) Treatment of unresectable lung metastases with transpulmonary chemoembolization: preliminary experience. Radiology 234:917–922
Vogl TJ, Lehnert T, Zangos S et al (2008) Transpulmonary chemoembolization (TPCE) as a treatment for unresectable lung metastases. Eur Radiol 18:2449–2455
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 45:228–247
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 267:627–637
Tait CR, Dodwell D, Horgan K (2004) Do metastases metastasize? J Pathol 203:515–518
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 104:1534–1541
Leung AM, Hari DM, Morton DL (2012) Surgery for distant melanoma metastasis. Cancer J 18:176–184
Locati LD, Guzzo M, Bossi P et al (2005) Lung metastasectomy in adenoid cystic carcinoma (ACC) of salivary gland. Oral Oncol 41:890–894
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
Nakamura T, Matsumine A, Yamakado K et al (2009) Lung radiofrequency ablation in patients with pulmonary metastases from musculoskeletal sarcomas [corrected]. Cancer 115:3774–3781
Hawkes EA, Ladas G, Cunningham D et al (2012) Peri-operative chemotherapy in the management of resectable colorectal cancer pulmonary metastases. BMC Cancer 12:326
Younes RN, Gross JL, Taira AM, Martins AA, Neves GS (2009) Surgical resection of lung metastases: results from 529 patients. Clinics (Sao Paulo) 64:535–541
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 14:1571–1576
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 32:464
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
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 22:65–71
Pfannschmidt J, Egerer G, Bischof M, Thomas M, Dienemann H (2012) Surgical intervention for pulmonary metastases. Dtsch Arztebl Int 109:652–658
Inderbitzi R, Rolle A (2001) Palliative surgery for primary and secondary thoracic malignancies. Ther Umsch 58:435–441
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The scientific guarantor of this publication is Prof. Dr. Thomas J. Vogl, Department of Diagnostic and Interventional Radiology, Goethe-University, Frankfurt/Main.
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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.
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No complex statistical methods were necessary for this paper.
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Written informed consent was not required for this study because of its retrospective nature.
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Institutional Review Board approval was obtained.
Methodology
• Retrospective
• Observational
• Performed at one institution
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Vogl, T.J., Mekkawy, A.I.A., Thabet, D.B. et al. Transvenous pulmonary chemoembolization (TPCE) for palliative or neoadjuvant treatment of lung metastases. Eur Radiol 29, 1939–1949 (2019). https://doi.org/10.1007/s00330-018-5757-8
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DOI: https://doi.org/10.1007/s00330-018-5757-8