Zusammenfassung
Die lokoregionale Chemotherapie der Lunge steht in Konkurrenz zu anderen Verfahren der perkutanen Tumorbehandlung. Die Applikation der Zytostatika über einen bronchialarteriellen Katheter ist zwar effektiv, hat sich aber wegen methodischer Schwierigkeiten nicht durchgesetzt. Das chirurgische Konzept der isolierten Lungenperfusion hat die Hoffnung geweckt, für die Chemotherapie auch den weniger aufwendigen Zugang über die A. pulmonalis wählen zu können. Im Tierexperiment erwies sich dabei die Kombination von Chemotherapie und Embolisation als überlegene Lösung. Die mit einer verwandten Technik erzielten klinischen Ergebnisse überzeugen aber nicht. Die pulmonalarterielle Chemotherapie stellt nur dann eine mögliche Alternative zur bronchialarteriellen Chemotherapie dar, wenn nachgewiesen ist, dass der Tumor aus der A. pulmonalis gespeist wird. Daher müssen vor der Entscheidung über eine Chemoembolisation der Lunge alle potenziell tumorversorgenden Gefäße identifiziert werden.
Abstract
Regional chemotherapy of the lungs competes with other techniques for percutaneous tumor treatment. Although effective, the application of cytostatic agents by means of a catheter placed in a bronchial artery has not been generally accepted because of procedural difficulties. The surgical concept of isolated lung perfusion raised hopes of performing chemotherapy via the more easily accessible pulmonary artery. Animal experiments proved the combination of chemotherapy and embolization to be the superior solution. However, the pertinent clinical results are unsatisfactory. Chemotherapy using a pulmonary catheter may be considered as being a potential alternative only for tumors where the vascular supply by the pulmonary artery is evident. Consequently, the identification of all potential tumor-supplying vessels is essential for the appropriate decision about chemoembolization of the lungs.
Literatur
Abolhoda A, Brooks A, Nawata S et al. (1997) Isolated lung perfusion with doxorubicin prolongs survival in a rodent model of pulmonary metastases. Ann Thorac Surg 64: 181–184
Asai T (1936) Experimental study of nutrient vessel of sarcoma transplanted into the lungs of rabbits. Jap J Cancer Res 30: 784–789
Burt ME, Liu D, Abolhoda A (2000) Isolated lung perfusion for patients with unresectable metastases from sarcoma: a phase I trial. Ann Thorac Surg 69: 1542–1549
Demmy TL, Wagner-Mann C, Allen A (2002) Isolated lung chemotherapeutic infusions for treatment of pulmonary metastases: a pilot study. J Biomed Sci 9: 334–338
Grootenboers MJ, Heeren J, Putte BP van et al. (2006) Isolated lung perfusion for pulmonary metastases, a review and work in progress. Perfusion 21: 267–276
He JG, Song HZ, Yan XF (1994) Interventional treatment of non-operable central lung cancer. Zhonghua Wai Ke Za Zhi 32: 106–107
Hellekant C (1979) Bronchialarteriographie und intraarterielle Chemotherapie beim Bronchuskarzinom. Radiologe 19: 521–527
Hellekant C, Jonsson K (1981) Double blood supply of bronchogenic carcinoma from multiple arteries. Acta Radiol Diagn (Stockh) 22: 403–406
Hendriks LM, Van Schill PE, Van Oosterom AA et al. (1999) Isolated lung perfusion with melphalan prolongs survival in a rat model of metastatic pulmonary adenocarcinoma. Eur Surg Res 31: 267–271
Hiraki T, Gobara H, Takemoto M et al. (2006) Percutaneous radiofrequency ablation combined with previous bronchial artery chemoembolization and followed by radiation therapy for pulmonary metastasis from hepatocellular carcinoma. J Vasc Interv Radiol 17: 1189–1193
Jardin M, Remy J (1988) Control of hemoptysis: systemic angiography and anastomoses of the internal mammary artery. Radiology 168: 377–383
Jiang GM, Zhao JW, Chen YX, Tian F (2006) Blood supply of pulmonary metastases and its clinical significance. Ai Zheng 25: 885–887
Johnston MR, Christensen CW, Minchin RF et al. (1985) Isolated total lung perfusion as a means to deliver organ-specific chemotherapy: long-term studies in animals. Surgery 98: 35–44
Johnston MR, Minchen RF, Dawson CA (1995) Lung perfusion with chemotherapy in patients with unresectable metastatic sarcoma to the lung or diffuse bronchioloalveloar carcinoma. J Thorac Cardiovasc Surg 110: 368–373
Karakousis CP, Park HC, Sharma SD, Kanter P (1981) Regional chemotherapy via the pulmonary artery for pulmonary metastases. J Surg Oncol 18: 249–255
Keller FS, Rösch J, Loflin TG et al. (1987) Non bronchial systemic collateral arteries: significance in percutaneous embolotherapy for hemoptysis. Radiology 164: 687–692
Matsuda A (1984) Bronchial arteriography in patients with pulmonary embolism. Chest 85: 767–773
Miller BJ, Rosenbaum AS (1967) The vascular supply to metastatic tumours of the lung. Surg Gynecol Obstet 125: 1009–1012
Ng B, Lenert JT, Weksler B et al. (1995) Isolated lung perfusion with FUDR is an effective treatment for colorectal adenocarcinoma lung metastases in rats. Ann Thorac Surg 59: 205–208
Ogilvie RW, Blanding JD Jr, Wood ML, Knisely WH (1964) The arterial supply to experimental metastatic VX2 and XY tumors in rabbit lung. Cancer Res 24: 1418–1430
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
Remy-Jardin M, Wattinne L, Remy J (1991) Transcatheter occlusion of pulmonary arterial circulation and collateral supply: failures, incidents, and complications. Radiology 180: 699–705
Reuter SR, Olin T, Abrams HL (1965) Selective bronchial arteriography. Radiology 78: 87–95
Schneider P, Kampfer S, Loddenkemper C et al. (2002) Chemoembolization of the lung improves tumor control in a rat model. Clin Cancer Res 8: 2463–2468
Schröder C, Fisher S, Pieck AC et al. (2002) Technique and results of hyperthermic (41 degrees C) isolated lung perfusion with high-doses of cisplatin for the treatment of surgically relapsing or unresectable lung sarcoma metastasis. Eur J Cardiothorac Surg 22: 41–46
Takeda J, Kakegawa T, Edakuni S et al. (1982) Effects of administration of an antineoplastic agent into the bronchial artery. Gan To Kagaku Ryoho 9: 129–133
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, Herzog C, Zangos S, Lindemayr S (2007) Transpulmonale Chemoembolisation (TPCE) als palliatives Behandlungskonzept bei primären Lungentumoren. Fortschr Röntgenstr 179: 300–307
Wang HY, Ng B, Ahrens C, Burt M (1994) Unilateral pulmonary artery occlusion inhibits growth of metastatic sarcoma in the rat lung. J Surg Oncol 57: 183–186
Wang HY, Ng B, Blumberg D et al. (1995) Pulmonary artery perfusion of doxorubicin with blood flow occlusion: pharmacokinetics and treatment in a metastatic sarcoma model. Ann Thorac Surg 60: 1390–1394
Wang HY, Hochwald S, Ng B, Burt ME (1996) Regional chemotherapy via pulmonary artery with blood flow occlusion in a solitary tumor nodule model. Anticancer Res 16: 3749–3753
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
Witt C, Schmidt B, Geisler A et al. (2000) Value of bronchial artery embolisation with platinum coils in tumorous pulmonary bleeding. Eur J Cancer 36: 1949–1954
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Golder, W. Chemoembolisation der Lunge. Onkologe 14, 934–939 (2008). https://doi.org/10.1007/s00761-008-1467-1
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DOI: https://doi.org/10.1007/s00761-008-1467-1