Prospective study of transarterial infusion of docetaxel and cisplatin to treat non-small-cell lung cancer in patients contraindicated for standard chemotherapy. Lung Cancer. 2012;77:353-358. [PMID: 22537620 DOI: 10.1016/j.lungcan.2012.04.006]

The Evolving Role of Intra-arterial Chemotherapy in Adult and Pediatric Cancers: A Comprehensive Review

The development of intra-arterial chemotherapy (IAC) was driven by an ambition to mitigate systemic side effects, enhance the bioavailability of drugs, and optimize the efficacy of chemotherapeutic agents. While the initial research on IAC primarily examined its effectiveness in treating various liver malignancies, the application of this treatment has undergone significant advancements since its introduction. The primary objective of this article is to examine the current range of utilization of IAC, both with and without radiotherapy, while also evaluating the results of relevant clinical trials. Furthermore, this article explores potential future advancements and opportunities in this field. From the scoping review of available articles, it can be concluded that IAC is an effective treatment alternative and, sometimes, a better first-line option, but there is a need for more evidence to make IAC a regular treatment option available for patients.

Innovative Invasive Loco-Regional Techniques for the Treatment of Lung Cancer

Surgical resection is still the standard treatment for early-stage lung cancer. A multimodal treatment consisting of chemotherapy, radiotherapy and/or immunotherapy is advised for more advanced disease stages (stages IIb, III and IV). The role of surgery in these stages is limited to very specific indications. Regional treatment techniques are being introduced at a high speed because of improved technology and their possible advantages over traditional surgery. This review includes an overview of established and promising innovative invasive loco-regional techniques stratified based on the route of administration, including endobronchial, endovascular and transthoracic routes, a discussion of the results for each method, and an overview of their implementation and effectiveness.

Bronchial artery chemoembolization with drug-eluting beads versus bronchial artery infusion followed by polyvinyl alcohol particles embolization for advanced squamous cell lung cancer: A retrospective study

PURPOSE

To analyze the efficacy and safety of bronchial arterial embolization (BACE) with drug-eluting beads (DEB) versus bronchial artery infusion (BAI) followed by polyvinyl alcohol (PVA) particle embolization for the treatment of advanced squamous cell lung cancer after the failure of systemic therapy.

METHOD

Thirty-six patients with advanced squamous cell lung cancer who underwent bronchial arterial interventional therapy were included in this retrospective study. The DEB group (n = 20) was treated with nedaplatin and DEB loaded with gemcitabine, and the PVA group (n = 16) BAI with nedaplatin and gemcitabine followed by embolization with PVA particles. The treatment efficacy and complications were analyzed.

RESULTS

The technical success rate was 100 %. The two groups were followed up for a median period of 8.9 months. The mean overall survival (OS) in the DEB group was 12.6 months (95 % CI:9.99-15.21), which was significantly longer than 8.14 months (95 % CI:6.07-10.2) in the PVA group (p = 0.007). The median progression-free survival (PFS) in the DEB group was 4.3 months (95 % CI:2.33-6.27), significantly longer than 3.2 months (95 % CI:2.55-3.85) in the PVA group (p = 0.030). The objective response rate (ORR) six months after the procedure was 50 % in the DEB group and 12.5 % in the PVA group. In the univariate and multivariate analyses, DEB-BACE was an independent prognostic factor for survival. Only grade 1 adverse events like fever, chest pain, and cough were seen.

CONCLUSIONS

DEB-BACE may be a good choice for patients with advanced lung squamous cell carcinoma, as it could prolong OS and PFS without increasing adverse events.

Clinical outcomes of vinorelbine loading CalliSpheres beads in the treatment of previously treated advanced lung cancer with progressive refractory obstructive atelectasis

Background: Drug-eluting beads bronchial arterial chemoembolization (DEB-BACE) has been used in the treatment of locally advanced lung cancer and has the potential to improve outcomes and reduce recurrence. However, DEB-BACE shows a poor therapeutic effect in advanced lung cancer after failure of multiple therapies. This study assessed the effect of DEB-BACE in the treatment of progressive lung cancer with refractory obstructive atelectasis. Methods: Progressive advanced lung cancer patients with refractory obstructive atelectasis were voluntarily enrolled in this study after failure of multiple conventional therapies. Baseline information, DEB-BACE treatment process, and changes in clinical symptoms were recorded. The primary endpoints were the objective response rate (ORR) and improvement rate of dyspnea. The secondary endpoints were time-to-progression (TTP), overall survival (OS), and rate of pulmonary re-expansion. Treatment-related adverse events and serious adverse events were analyzed to assess the safety of DEB-BACE. The Cox regression model was performed to analyze the possible factors impacting prognosis of DEB-BACE. Results: DEB-BACE was successfully performed with CalliSpheres beads loaded with vinorelbine in the 20 enrolled patients. ORR and disease control rate were 80% and 85%, respectively, at the first follow-up (43.4 ± 15.26 days). The improvement rate of dyspnea was 85% and 80% at 1 week and 1 month (p < 0.0001, p < 0.0001), respectively. TTP was 41.25 ± 14.43 days and 89.55 ± 61.7 days before and after DEB-BACE, respectively; DEB-BACE delayed the progression of advanced lung cancer (p < 0.0001). OS was 238.03 ± 33.74 days (95% confidence interval: 171.9-304.16). The rate of pulmonary re-expansion was 80% at the first follow-up. The reasons for poor prognosis were tumor necrosis, longer disease duration, and pulmonary atelectasis duration (p = 0.012, p = 0.038, p = 0.029). Massive hemoptysis was observed in two cases, and one patient died of asphyxia caused by hemoptysis. Moderate hemoptysis occurred in one case. All three adverse events were considered as the result of the tumor cavity after DEB-BACE. Conclusion: DEB-BACE loaded with vinorelbine is a feasible option for progressive advanced lung cancer with obstructive atelectasis after failure of other treatments.

Drug-Eluting Bead Bronchial Arterial Chemoembolization With and Without Microwave Ablation for the Treatment of Advanced and Standard Treatment-Refractory/Ineligible Non-Small Cell Lung Cancer: A Comparative Study

Purpose

To compare the outcomes of drug-eluting bead bronchial arterial chemoembolization (DEB-BACE) with and without microwave ablation (MWA) for the treatment of advanced and standard treatment-refractory/ineligible non-small cell lung cancer (ASTRI-NSCLC).

Materials and Methods

A total of 77 ASTRI-NSCLC patients who received DEB-BACE combined with MWA (group A; n = 28) or DEB-BACE alone (group B; n = 49) were included. Clinical outcomes were compared between groups A and B. Kaplan–Meier methods were used to compare the median progression-free survival (PFS) or overall survival (OS) between the two groups. Univariate and multivariate Cox proportional hazards analyses were used to investigate the predictors of OS for ASTRI-NSCLC treated with DEB-BACE.

Results

No severe adverse event was found in both groups. Pneumothorax was the predominant MWA-related complication in group A, with an incidence rate of 32.1% (9/28). Meanwhile, no significant difference was found in DEB-BACE-related complications between groups A and B. The overall disease control rate (DCR) was 61.0% (47/77), with a significantly higher DCR in group A (85.7% vs. 46.9%, P = 0.002). The median PFS in groups A and B was 7.0 and 4.0 months, respectively, with a significant difference (P = 0.037). The median OS in groups A and B was both 8.0 months, with no significant difference (P = 0.318). The 6-month PFS and OS rates in groups A and B were 75.0% and 78.6%, 22.4% and 59.2%, respectively, while the 12-month PFS and OS rates in groups A and B were 17.9% and 28.6%, 14.3% and 22.4%, respectively. Of these, a significantly higher 6-month PFS rate was found in group A (75.0% vs. 22.4%; P < 0.001). The cycles of DEB-BACE/bronchial artery infusion chemotherapy [hazard ratio (HR): 0.363; 95% confidence interval (CI): 0.202–0.655; P = 0.001] and postoperative immunotherapy (HR: 0.219; 95% CI: 0.085–0.561; P = 0.002) were identified as the predictors of OS in ASTRI-NSCLC treated with DEB-BACE.

Conclusion

MWA sequentially combined with DEB-BACE was superior to DEB-BACE alone in the local control of ASTRI-NSCLC. Although the combination therapy reveals a trend of prolonging the OS, long-term prognosis warrants an investigation with a longer follow-up.

Self-Expandable Metallic Stent Implantation Combined With Bronchial Artery Infusion Chemoembolization in the Treatment of Lung Cancer With Complete Atelectasis

Background

Atelectasis is a common complication of lung cancer, and there are few reports about the treatment methods. This study retrospectively analyzed the safety and effectiveness of endotracheal metal stent implantation combined with arterial infusion chemoembolization in the treatment of non-small cell lung cancer with complete atelectasis.

Methods

The clinical data of patients with non-small cell lung cancer and complete atelectasis treated by self-expandable metallic stent implantation combined with arterial infusion chemotherapy were retrospectively analyzed. The clinical efficacy was evaluated and postoperative adverse reactions were observed. Progression-free survival and overall survival were analyzed by Kaplan-Meier method.

Results

In all, 42 endotracheal metallic stents were implanted in 42 patients under fluoroscopy. 5–7 days after stent implantation, CT showed that 24 patients (57.1%) had complete lung recruitment, and that 13 (31.0%) had partial lung recruitment. The technical success rate was 100%, and the clinical success rate was 88.1% (37/42). 5–7 days after stent implantation, bronchial artery infusion chemoembolization was performed in all patients. The median progression-free survival and overall survival were 6 months (95% CI: 2.04-9.66) and 10 months (95% CI: 7.22-12.79), respectively.

Conclusion

Self-expandable metallic stent implantation combined with arterial infusion chemoembolization may be an effective and safe strategy in the treatment of lung cancer with atelectasis clinically.

Successful eight-year survival of unresectable lung adenocarcinoma with bronchial artery infusion chemotherapy: A case report

A case report of eight year complete remission post bronchial artery infusion (BAI) chemotherapy (Pimetrazine and cisplatin) for unresectable lung adenocarcinoma.

Sintilimab plus Bronchial Arterial Infusion Chemotherapy/Drug-Eluting Embolic Chemoembolization for Advanced Non-Small Cell Lung Cancer: A Preliminary Study of 10 Patients

PURPOSE

To evaluate the short-term efficacy and safety of immunotherapy with sintilimab combined with bronchial arterial infusion (BAI) chemotherapy/drug-eluting embolic (DEE) bronchial arterial chemoembolization (BACE) for advanced non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

Ten patients with advanced NSCLC were treated with sintilimab plus BAI/DEE-BACE between December 2019 and November 2020 and retrospectively evaluated. The Response Evaluation Criteria in Solid Tumors version 1.1 was applied to evaluate the treatment response. The local tumor control duration, progression-free survival (PFS), and overall survival (OS) were estimated using the Kaplan-Meier analysis.

RESULTS

At 30 days after the last multimodal treatment, complete response, partial response, and stable disease were recorded in 1 (10%), 7 (70%), and 2 (20%) patients, respectively, for an objective response rate of 80% and a disease control rate of 100%. No patient experienced progressive disease. The median duration of local tumor control was 8.0 months (95% CI, 6.2-9.7 months). The median PFS and OS were 11.0 months (95% CI, 6.9-15.1 months) and 8.0 months (95% CI, 5.5-10.5 months), respectively. Two cases of Grade III adverse events related to medications were reported.

CONCLUSIONS

Sintilimab combined with BAI/DEE-BACE for patients with advanced NSCLC appears to be safe and feasible. Compared with previous studies on BAI/DEE-BACE, the addition of immunotherapy may improve survival.

Common trunk of the right accessory renal artery and right inferior phrenic artery originating from the thoracic artery: An unreported variation

Accessory renal arteries (ARAs) are common and usually originate from the abdominal aorta and the renal artery. Inferior phrenic arteries (IPAs) can also arise from the abdominal aorta or its branches. In this paper, we present the first case of a common trunk of the right ARA and right IPA arising from the thoracic artery at the level of T10, which was discovered by multidetector-row computed tomography in pretherapeutic evaluation and clearly confirmed by selective angiography. It is important to recognize this anatomical variation when performing cardiovascular and interventional radiological procedures.

Establishment of a large animal model for research on transbronchial arterial intervention for lung cancer

PURPOSE

We aimed to evaluate whether bronchial artery can supply a percutaneously inoculated canine transmissible venereal tumor (CTVT) in a lung tumor model.

METHODS

Fresh CTVT tissue blocks were percutaneously inoculated into unilateral or bilateral lungs of six immunosuppressed dogs at the mid zone of the middle or lower lobe. Tumor growth was monitored by computed tomography (CT). Ten weeks after inoculation, pulmonary arterial digital subtraction angiography (DSA), bronchial arterial DSA, transpulmonary arterial contrast-enhanced multislice CT, transbronchial arterial contrast-enhanced multislice CT (BA-MSCT), and transpulmonary arterial lipiodol multislice CT were performed.

RESULTS

Tumor growth was seen in all 10 inoculated sites, with a maximum diameter of 2.734±0.138 cm at 10th week. Bronchial arterial blood supply was evident in 9 nodules on DSA, and was equivocal in one which was later demonstrated on BA-MSCT. No obvious pulmonary arterial blood supply was observed in any of the nodules. Lipiodol deposition was displayed in two of the small distant metastases, which indicated that pulmonary artery was involved in the supply of the metastases.

CONCLUSION

Our results demonstrated bronchial arterial blood supply in this new lung cancer model. This model may be used in further research on transbronchial arterial intervention for lung cancer.

Successful bronchial arterial infusion chemotherapy combined with radiotherapy for an endobronchial metastasis after resection of small cell lung cancer

Bronchial arterial infusion (BAI) chemotherapy has been reported to be an effective treatment option for centrally located early-stage squamous cell lung cancer (SCC) and has a favourable response rates for patients with stage III or IV or recurrent non-small cell lung cancer (NSCLC) without distant metastases who cannot tolerate standard chemotherapy. Here, we report a case of an 83-year-old male with a solitary polypoid endobronchial metastatic tumour in the left main bronchus one year and 10 months after video-assisted thoracoscopic surgery (VATS) combined segmentectomy (left S6 + S8a) for small cell lung cancer (SCLC), pT1bN0. He was treated with BAI of 100 mg of cis-Diamminedichloroplatinum/cisplatin (CDDP), followed by thoracic radiotherapy (56 Gy in 28 fractions). There was no recurrence for 2.5 years. BAI chemotherapy combined with radiotherapy seemed to be an effective salvage option for the treatment of solitary endobronchial metastases of SCLC in patients unfit for standard chemoradiotherapy.

Microwave Ablation Versus Wedge Resection for Stage I Non-small Cell Lung Cancer Adjacent to the Pericardium: Propensity Score Analyses of Long-term Outcomes

Objective

The present study has compared the long-term outcomes between performing wedge resection (WR) and microwave ablation (MWA) as first-line treatment of stage I non–small cell lung cancer (NSCLC) patients with tumors adjacent to the pericardium.

Materials and Methods

Between January 2014 and December 2018, a total of 223 consecutive patients with T1N0 NSCLC underwent first-line treatment by WR (n = 155) or image-guided lung MWA (n = 68). This study has compared the progression-free survival (PFS) and overall survival (OS) rates between the two treatments before and after propensity score matching. Subgroup analysis of these outcomes was conducted based on the distance from the pericardium.

Results

The median follow-up time was 47 months. Propensity matching yielded 56 pairs of patients. In the two matched groups, the PFS rates in the WR group at 3 and 5 years were 66.0% and 56.0% and 54.0% and 36.0%, respectively, in the MWA group (P = 0.029). Meanwhile, the corresponding OS rates for the WR group at 3 and 5 years were 81.0% and 72.0% and 60.0% and 55.0% in the MWA group, respectively (P = 0.031). Subgroup analysis, done according to the treatment modality, indicated that local tumor recurrence and PFS for NSCLCs that were close but not contiguous to the pericardium were different from those contiguous to the pericardium (P = 0.018 and P = 0.025, respectively).

Conclusion

WR provided better long-term tumor control and OS compared to MWA for stage I NSCLC adjacent to the pericardium as a first-line treatment. MWA can be considered as an alternative option for high-risk and inoperable patients, particularly for tumors that were not contiguous to the pericardium.

Effectiveness of bronchial arterial embolization using N-butyl-2-cyanoacrylate for local control of pulmonary hilar or mediastinal tumors that are refractory to chemotherapy

PURPOSE

To investigate local control and survival after bronchial artery embolization (BAE) using N-butyl-2-cyanoacrylate (NBCA) for pulmonary hilar or mediastinal tumors that are refractory to chemotherapy or chemoradiotherapy.

METHOD

This is a single center retrospective study involving 42 patients treated between 2015 and 2018 for pulmonary hilar or mediastinal tumors (primary tumors in 5 and metastatic ones in 37). Tumor histology was sarcoma in 22 and carcinoma in 20 patients. All patients had shown tumor progression regardless of previous chemotherapy (n = 37) or chemoradiotherapy (n = 5). Thirty-seven patients (88 %) had respiratory symptoms, such as cough, dyspnea, and hemoptysis. BAE was performed using NBCA to shrink tumors for extending life expectancy. Target tumors were followed with computed tomography at 1,3, and 6 months after BAE. Endpoints included the best tumor response within 6 months as well as overall survivals in patients with and without tumor responses.

RESULTS

Best local responses within 6 months were complete response (CR) in 1 patient, partial response (PR) in 16, stable disease (SD) in 24, and progressive disease (PD) in 1; the CR/PR rate was 40 % (17/42). Median follow-up period was 13 months (range:1-43). Overall survival in patients with CR/PR was significantly better than in those with SD/PD (p = 0.006); with 3-year survival rates of 45 % (8/17) and 0% (0/25), respectively.

CONCLUSIONS

BAE using NBCA has potential promise for shrinking hilar and/or mediastinal tumors that are refractory to chemotherapy or chemoradiotherapy, and may also improve overall survival in patients who respond.

Combination of computed tomography-guided iodine-125 brachytherapy and bronchial arterial chemoembolization for locally advanced stage III non-small cell lung cancer after failure of concurrent chemoradiotherapy

OBJECTIVES

To evaluate the efficacy and safety of the combination of computed tomography (CT)-guided iodine-125 brachytherapy and bronchial arterial chemoembolization (BACE) for locally advanced stage III non-small cell lung cancer (NSCLC) after failure of concurrent chemoradiotherapy.

MATERIAL AND METHODS

We retrospectively evaluated 28 patients with locally advanced stage III NSCLC in whom concurrent chemoradiotherapy had failed and were consequently, treated with radioactive iodine-125 seed implantation followed by BACE. The prescribed radiation dose was 140 Gy, with a median radioactivity of 0.60 mCi. The tumor-feeding arteries were detected on angiography, and chemotherapeutic agents (gemcitabine 1000 mg/m² + lobaplatin 30 mg/m²) were then administered via arterial infusion. The tumor-feeding arteries were embolized using 300-500 μm embosphere microspheres. The endpoints were treatment response rate, progression-free survival (PFS), and toxicity.

RESULTS

The median number of implanted iodine-125 seeds was 58 pellets (range, 44-114 pellets). The median post-operative dose covering 90 % of the target volume (D90) was 143.4 Gy (range, 123.6-159.9 Gy). A total of 73 cycles of BACE were conducted (2.61 cycles per case). The bronchial arteries were the main tumor-feeding arteries. In total, 11 patients had hemoptysis, and it was significantly alleviated within 24 h after BACE. There was no serious procedure-related complication. The 6-month objective response and disease control rates were 71.42 % and 92.86 %, respectively. No severe complications occurred during the follow-up. Local control duration ranged from 5-12 months, and the median PFS was 8 months (95 % confidence interval: 7.3-8.8 months).

CONCLUSIONS

The combination of CT-guided iodine-125 brachytherapy and BACE is an effective and safe approach for the treatment of NSCLC after failure of concurrent chemoradiotherapy and is worthy of clinical application.

Gefitinib with or without Transarterial Infusion Chemotherapy (Cisplatin) for Large Nonsmall Cell Lung Cancer with Epidermal Growth Factor Receptor Mutations

PURPOSE

To retrospectively investigate the safety and benefit of gefitinib plus transarterial infusion (TAI) therapy as a first-line treatment compared to gefitinib alone for patients with large (>7 cm) nonsmall cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations.

MATERIALS AND METHODS

Between January 2010 and December 2013, 92 consecutive treatment-naïve patients with large NSCLC with EGFR mutations, who were treated using gefitinib plus TAI (G+T, n = 42) or gefitinib alone (G, n = 50) were reviewed. The primary endpoints were the objective response rate (ORR) and tumor reduction rate. The secondary endpoints were progression-free survival (PFS) and overall survival (OS), and safety was also assessed.

RESULTS

The baseline characteristics of the 2 groups were balanced, and no patients experienced treatment-related death. Toxicity outcomes did not differ between the G+T and G groups. The tumor reduction rate in the G+T group was significantly higher than that in the G group (42.9 vs 31.9%, P = .028). The ORR was 83% in the G+T group and 72% in the G group (P = .197). The median PFS was significantly longer in the G+T group than in the G group (14.0 vs 10.0 months, P = .023). The median OS was 30.0 months in the G+T group and 27.0 months in the G group (P = .235).

CONCLUSIONS

This study suggests that compared with gefitinib alone, combination therapy with gefitinib plus TAI was well tolerated and potentially improved the tumor reduction rate and PFS in patients with large NSCLC with EGFR mutations.

Achievable complete remission of advanced non-small-cell lung cancer: Case report and review of the literature

Surgery is the first choice of treatment for patients with non-small-cell lung cancer (NSCLC), but few patients can be treated surgically because of either advanced disease or poor pulmonary function. Other therapies include radiotherapy and chemotherapy, as well as complementary and alternative therapies, usually with disappointing results. Bronchial artery infusion (BAI) is a manageable and effective method for treating advanced NSCLC. Outcome is good by BAI due to its repeatability and low toxicity. Icotinib hydrochloride is a newly developed and highly specific epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor and has been safely and efficiently used to treat advanced NSCLC. We herein report a 73-year-old patient with chronic cough, who was diagnosed with advanced NSCLC with the EGFR mutation of L858R substitution in exon 21, and treated with the combination of oral icotinib and BAI chemotherapy as the first-line therapy, which resulted in a satisfactory clinical outcome. Complete remission of advanced NSCLC can be achieved using the combination of oral icotinib and BAI chemotherapy.

Transcatheter Arterial Chemoembolization with Spherical Embolic Agent in Patients with Pulmonary or Mediastinal Metastases from Breast Cancer

PURPOSE

To evaluate safety and feasibility of transcatheter arterial chemoembolization with superabsorbent polymer microspheres (SAP-MS) for patients with pulmonary or mediastinal metastasis from breast cancer.

METHODS

Between November 2002 and January 2015, 14 patients with 29 unresectable pulmonary or mediastinal breast cancer metastases underwent transcatheter arterial chemoembolization using SAP-MS (50-100 μm) after injection of a combination of 2-4 types of anticancer drugs (eg, cisplatin [30 mg] + fluorouracil [500 mg], or epirubicin [40 mg] + mitomycin C [4 mg] + fluorouracil [500 mg]). As a primary endpoint, local tumor response and adverse events were evaluated 1 month after the first transcatheter arterial chemoembolization, according to Response Evaluation Criteria In Solid Tumors Version 1.1 and Common Terminology Criteria for Adverse Events Version 4 criteria. Transcatheter arterial chemoembolization was repeated as needed. Overall survival was analyzed as a secondary endpoint.

RESULTS

Response rate was 28.6% (partial response, 4 patients; stable disease, 10 patients). Median progression rate was -12.7%. No cases of hematologic toxicity of grade 3 or higher were observed. A grade 3 maculopapular rash was observed in 1 patient. After the first transcatheter arterial chemoembolization sessions, 63 additional transcatheter arterial chemoembolization sessions were performed (average, 5.5 sessions per patient; range, 2-10 sessions). The median overall survival time after the first session was 29 months, and the 5-year survival rate was 49.5%.

CONCLUSIONS

Transcatheter arterial chemoembolization with SAP-MS is a well-tolerated and feasible palliative treatment option for patients with pulmonary or mediastinal metastasis from breast cancer.

Neoadjuvant chemotherapy by bronchial arterial infusion in patients with unresectable stage III squamous cell lung cancer

BACKGROUND

We investigated the effects of neoadjuvant chemotherapy administered via bronchial arterial infusion (BAI) on unresectable stage III lung squamous cell carcinoma (SCC).

METHODS

This was a single-arm retrospective study of chemotherapy with gemcitabine plus cisplatin (GP) administered via BAI to patients with unresectable lung SCC. Data regarding the post-treatment response rate, downstage rate, and surgery rate, as well as progression-free survival (PFS), overall survival (OS), quality of life, and post-BAI side effects were collected.

RESULTS

A total of 36 patients were enrolled in this study between August 2010 and May 2014. The response rate was 72.2%, and the downstage rate was 22.2%. Among the patients who were downstaged, 16 (44.4%) patients were because of their T stage, and 5 (13.9%) patients were downstaged due to to their N stage. The surgery rate was 52.8%, the 1-year survival rate was 75.4%, and the 2-year survival rate was 52.1%. The median PFS was 14.0 months [95% confidence interval (CI): 8.6-19.4], and the median OS was 25.0 months (95% CI: 19.1-30.9). The quality of life was significantly improved, and the chemotherapy was well tolerated.

CONCLUSIONS

Compared with intravenous neoadjuvant chemotherapy, BAI chemotherapy significantly improved the surgery rate, prolonged PFS and OS, and improved the quality of life in patients with unresectable stage III lung SCC.

Transarterial chemoembolization for management of hemoptysis: initial experience in advanced primary lung cancer patients

PURPOSE

To evaluate the hemostatic effects of transarterial infusion chemotherapy in addition to embolization (chemoembolization) for advanced primary lung cancer with tumor-related hemoptysis.

MATERIALS AND METHODS

Ten consecutive patients with stage IIIB/IV or recurrent primary lung cancer (squamous cell carcinoma in six, adenocarcinoma in four) who underwent chemoembolization for control of hemoptysis were enrolled. At enrollment, five patients were considered refractory and five had contraindications to standard therapies. The amount of hemoptysis was massive in two patients, moderate in seven, and slight in one. Transarterial infusion chemotherapy via feeding arteries using cisplatin (25 mg/m²) and 5-fluorouracil (300 mg/m²) was repeated every 3-4 weeks for three cycles. HepaSphere (100-150 µm) or gelatin sponge particles were selected as embolic materials depending on the presence of pulmonary shunts and were added for embolization just after drug infusion.

RESULTS

Hemoptysis improved in all patients (resolution in nine, significant decrease in one). The median hemostasis time was 11.9 months (range 2.7-25.9 months). The target pulmonary lesions shrank in seven patients, and pulmonary atelectasis disappeared in three of five patients.

CONCLUSIONS

Chemoembolization may be a palliative option with favorable hemostasis time for advanced primary lung cancer with hemoptysis.

The Role of Interventional Oncology in the Management of Lung Cancer

Interventional radiological procedures for diagnosis and treatment of lung cancer have become increasingly important. Imaging-guided percutaneous biopsy has become the modality of choice for diagnosing lung cancer, and in the era of target therapies, it is an useful tool to define earlier patient-specific tumor phenotypes. In functionally inoperable patients, especially the ablative procedures are potentially curative alternatives to surgery. In addition to thermally ablative treatment, selective chemoembolization by a vascular access allows localized therapy. These treatments are considered for patients in a reduced general condition which does not allow systemic chemotherapy. The present article reviews the role of interventional oncology in the management of primary lung cancer, focusing on the state of the art for each procedure.

Transarterial Therapy for Colorectal Liver Metastases

Until recently, hepatic arterial therapies (HAT) had been used for colorectal liver metastases after failure of first-, second-, and third-line chemotherapies. HAT has gained greater acceptance in patients with liver-dominant colorectal metastases after failure of surgery or systemic chemotherapy. The current data demonstrate that HAT is a safe and effective option for preoperative downsizing, optimizing the time to surgery, limiting non-tumor-bearing liver toxicity, and improving overall survival after surgery in patients with colorectal liver-only metastases. The aim of this review is to present the current data for HAT in liver-only and liver-dominant colorectal liver metastases.

Endostatin combined with platinum-based chemo-radiotherapy for advanced non-small cell lung cancer

This retrospective study was conducted to determine whether endostatin improves the efficacy and safety of platinum-based chemotherapy administered via both intravenous and arterial infusions for stage III/IV non-small-cell lung cancer (NSCLC). Seventy one patients with confirmed pathological or cytological diagnosis of NSCLC from January 2008 to March 2013 were enrolled for the study. Patients received three different therapeutic regimens until disease progression or an intolerable toxicity was evidenced. Group C received chemotherapy administered by intravenous injection and subsequent radiotherapy. Group IC received chemotherapy by intravenous injection and arterial infusion plus radiotherapy. Group IC + E patients were treated with chemotherapy plus Endostatin injected arterially and intravenously and subsequent radiotherapy. Group IC + E showed a progression-free survival (PFS) of 12 months as compared to 7 months of group C, a significant increase indeed (p = 0.037). Likewise, the overall survival time higher in Group IC + E and Group IC was compared to Group C (p = 0.001; p = 0.004, respectively). The adverse or toxic side effects exhibited by Group IC + E were not significantly different from either Group IC or Group C. Endostatin administered in combination with chemotherapeutic agents via both intravenous injection and arterial infusion enhanced the PFS and OS in advanced NSCLC without increasing the risk of toxicity.

Transcatheter arterial chemical infusion for advanced non-small-cell lung cancer: long-term outcome and predictor of survival

PURPOSE

To evaluate the long-term outcome and the predictor of survival in patients treated with transcatheter arterial chemical infusion for advanced non-small-cell lung cancer (NSCLC).

MATERIALS AND METHODS

From May 2008 to August 2014, a total of 40 consecutive patients with advanced NSCLC who underwent transcatheter arterial chemical infusion were enrolled in this retrospective study. Data on patients' characteristics, treatment response and follow-up were collected and analyzed.

RESULTS

A total of 142 cycles of transcatheter arterial chemical infusion were administered to the 40 patients (3.55 cycles per case). In 21 patients, only the bronchial artery was the tumor feeding artery, while in the remaining 19 patients, other arteries in addition to the bronchial artery served as the tumor feeding arteries. Five patients underwent bronchial arterial embolization after transcatheter arterial chemical infusion. There was no serious procedure-related complication. During 1-60 months (mean 11.5 ± 10.0 months) follow-up, 33 patients died. The objective response and disease control rates were 32.5 and 92.5 %, respectively. The mean time to tumor progression and overall survival was 9.2 ± 1.4 and 13.1 ± 2.0 months, respectively. Based on univariate and multivariate analyses, the independent predictors of decreasing overall survival were airway, esophagus, or superior vena cava involvement (P = 0.037) and more tumor feeding arteries in addition to the bronchial artery (P = 0.003).

CONCLUSION

Transcatheter arterial chemical infusion is an easy and effective method for treating patients with advanced NSCLC and it can provide a favorable long-term outcome.

Anomalous Posterior Intercostal Arterial Trunk Arising From the Abdominal Aorta

A common trunk of the ipsilateral posterior intercostal artery (PIA) arising from the thoracic aorta is usually an anatomical variation. However, a common trunk of bilateral posterior intercostal arterial trunk (PIAT) arising from the abdominal aorta is rare. It is important to recognize this anatomical variation of PIA when performing interventional radiological procedures. We present a rare case of an anomalous PIAT that originated from the abdominal aorta in a patient with hemoptysis caused by tuberculosis sequelae. Bilateral 4th to 11th PIAs arose from a common trunk and the trunk arising from the posterior aspect of the abdominal aorta at the level of T12/L1 intervertebral space. The pathological right 4th and 5th PIAs and bronchial arteries were embolized. Hemoptysis has been controlled for 3 months.

Transarterial chemoembolization (TACE) for colorectal liver metastases--current status and critical review

BACKGROUND

Transarterial liver-directed therapies are currently not recommended as a standard treatment for colorectal liver metastases. Transarterial chemoembolization (TACE), however, is increasingly used for patients with liver-dominant colorectal metastases after failure of surgery or systemic chemotherapy. The limited available data potentially reveals TACE as a valuable option for pre- and post-operative downsizing, minimizing time-to-surgery, and prolongation of overall survival after surgery in patients with colorectal liver only metastases.

PURPOSE

In this overview, the current status of TACE for the treatment of liver-dominant colorectal liver metastases is presented. Critical comments on its rationale, technical success, complications, toxicity, and side effects as well as oncologic outcomes are discussed. The role of TACE as a valuable adjunct to surgery is addressed regarding pre- and post-operative downsizing, conversion to resectability as well as improvement of the recurrence rate after potentially curative liver resection. Additionally, the concept of TACE for liver-dominant metastatic disease with a focus on new embolization technologies is outlined.

CONCLUSIONS

There is encouraging data with regard to technical success, safety, and oncologic efficacy of TACE for colorectal liver metastases. The majority of studies are non-randomized single-center series mostly after failure of systemic therapies in the 2nd line and beyond. Emerging techniques including embolization with calibrated microspheres, with or without additional cytotoxic drugs, degradable starch microspheres, and technical innovations, e.g., cone-beam computed tomography (CT) allow a new highly standardized TACE procedure. The real efficacy of TACE for colorectal liver metastases in a neoadjuvant, adjuvant, and palliative setting has now to be evaluated in prospective randomized controlled trials.

Local control and prognostic significance of transarterial treatment for limited recurrence of ovarian cancer as third-line and beyond therapy

BACKGROUND

We aimed to retrospectively evaluate the safety and efficacy of transarterial treatment for the recurrence of ovarian cancer, limited to one or two gross regions, in a palliative setting as third-line and beyond therapy.

METHODS

Twenty-six consecutive patients were enrolled to undergo transarterial treatment of target lesions that were life-threatening or influenced their quality of life. Transarterial infusion via each feeding artery using 20-40 mg cisplatin and 20-40 mg docetaxel per patient was repeated every 4-6 weeks. Superabsorbent polymer microspheres were added for embolization after drug infusion, especially in hepatic or pelvic treatments. Univariate and multivariate Cox's proportional hazards models were used to assess the correlations between overall survival and individual parameters.

RESULTS

A total of 63 feeding arteries (median 2 per patient; range 1-5) were treated for 36 target sites (liver, 12; pelvis, 8; abdominal cavity, 7; lymph node, 3; other, 6) at the initial treatment. Of the 128 total sessions, the only grade 3/4 toxicity was neutropenia (3.8 %). The target lesion response rate by RECIST ver.1.1 was 50.0 % (11.5 % complete response; 38.5 % partial response). After a median follow-up of 30 months, the median overall survival was 16 months. Among 10 tumor-associated symptomatic patients, 7 showed symptom improvement. Multivariate analyses shows that the only independent prognostic factor was target lesion response (hazard ratio 18.7; 95 % CI 1.9-183.4; p = 0.01).

CONCLUSIONS

Transarterial treatment for ovarian cancer achieves a high local response and good symptom control, and significantly contributes to survival for patients with local control after multiple relapses.

Intra-arterial infusion chemotherapy for advanced non-small-cell lung cancer: preliminary experience on the safety, efficacy, and clinical outcomes

PURPOSE

To investigate the effectiveness and toxicity of intra-arterial infusion chemotherapy as a therapeutic modality for advanced non-small-cell lung cancer (NSCLC).

MATERIALS AND METHODS

In a retrospective study, 40 patients with stage III NSCLC received intra-arterial infusion chemotherapy with gemcitabine and cisplatin. Tumor staining was graded based on angiography, and the number of NSCLC feeding arteries detected was recorded. Toxicity was assessed according to National Cancer Institute Common Toxicity Criteria for Adverse Events. The response to treatment was evaluated per Response Evaluation Criteria In Solid Tumors (RECIST). Efficacy was assessed based on time to tumor progression (TTP), and survival was estimated by Kaplan-Meier analysis. Prognostic factors influencing TTP and overall survival rate were evaluated by Cox regression analysis.

RESULTS

The most frequent drug-related adverse events were cough (n = 17; 42.5%), anorexia (n = 14; 35%), and pain (n = 9; 22.5%). Evaluated per RECIST, a total of 47.5% of patients (n = 19) exhibited response to therapy after completion of the first three cycles of intra-arterial infusion chemotherapy. The median TTP was 5 months. Patients had a median life expectancy of 9 months. By Cox regression analysis, tumor staining was shown to be an independent prognostic factor for TTP (relative risk, 0.405; 95% confidence interval, 0.216-0.760) and overall survival (relative risk, 0.348; 95% confidence interval, 0.185-0.656).

CONCLUSIONS

Intra-arterial infusion chemotherapy for advanced lung cancer has the potential to reduce the size of tumors and has no severe adverse effects.