Bronchial or Pulmonary Artery Chemoembolization for Unresectable and Unablatable Lung Metastases.

Abstract

HomeRadiology: Imaging CancerVol. 3, No. 6 PreviousNext Research HighlightsFree AccessBronchial or Pulmonary Artery Chemoembolization for Unresectable and Unablatable Lung MetastasesMaximiliano KlugMaximiliano KlugMaximiliano KlugPublished Online:Nov 26 2021https://doi.org/10.1148/rycan.2021219023MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major Focus: A phase I clinical trial study prospectively evaluated the success rate and safety of transarterial chemoembolization (TACE) of bronchial or pulmonary arteries using ethiodized oil, mitomycin, and microspheres for treatment of unresectable and unablatable lung metastases.■ Key Results: Technical efficacy was 100% with no immediate major adverse events reported. Forty percent of patients showed partial metabolic response according to the PET Response Criteria in Solid Tumors (PERCIST).■ Impact: Lung TACE is a safe and technically achievable procedure with promising results for large and multifocal lung metastases with limited treatment options. Larger multicenter randomized clinical trials are needed to further evaluate safety and efficacy.Prognosis is poor for unresectable and unablatable lung metastases when they stop responding to systemic chemotherapy. Lung TACE of the pulmonary or bronchial arteries is an emerging treatment option for large and multifocal lung tumors, although response rate remains low. The authors hypothesize that the potential dual blood supply of lung tumors from bronchial or pulmonary arteries limits success of TACE.The single-center study prospectively enrolled patients with unresectable and unablatable lung, endobronchial, mediastinal, or pleural metastases from any primary tumor except lung cancer for which systemic chemotherapy failed. Nine of 10 patients had metastatic colorectal cancer. On the basis of pretreatment pulmonary and bronchial angiography, the authors performed chemoembolization with ethiodized oil, mitomycin, and microspheres through the artery that showed greater perfusion tumor enhancement at angiography. The study defined technical success by delivery of ethiodized oil and mitomycin into an artery supplying a target tumor, with safety assessment ending 6 weeks after the procedure. Using untreated tumors in a patient as an internal control, the team measured response to therapy by PERCIST and Response Evaluation Criteria in Solid Tumors (RECIST).The study reports that the technical success of intratumoral drug delivery was 100% with no severe adverse effects. However, both forced vital capacity and forced expiratory volume in 1 second decreased persistently through 4–6 weeks. Partial response rates after 4–6 weeks were 40% and 10% by PERCIST and RECIST, respectively. All colorectal metastases had bronchial artery supply, and tumor response by PERCIST correlated with concentration of ethiodized oil in a tumor.Although limited by small numbers of patients, the demonstrated efficacy and safety obtained and preliminary partial response rates encourage future larger clinical trials. Correctly identifying the vascular anatomy of lung metastases in unresectable and unablatable disease may be key for future improvements in TACE for lung metastases.Highlighted ArticleBoas FE, Kemeny NE, Sofocleous CT, et al. Bronchial or pulmonary artery chemoembolization for unresectable and unablatable lung metastases: a phase I clinical trial. Radiology 2021;301(2):474–484. doi: https://doi.org/10.1148/radiol.2021210213Highlighted ArticleBoas FE, Kemeny NE, Sofocleous CT, et al. Bronchial or pulmonary artery chemoembolization for unresectable and unablatable lung metastases: a phase I clinical trial. Radiology 2021;301(2):474–484. doi: https://doi.org/10.1148/radiol.2021210213 Link, Google ScholarArticle HistoryPublished online: Nov 26 2021 FiguresReferencesRelatedDetailsRecommended Articles Bronchial or Pulmonary Artery Chemoembolization for Unresectable and Unablatable Lung Metastases: A Phase I Clinical TrialRadiology2021Volume: 301Issue: 2pp. 474-484Chemoembolization for Lung Neoplasms: Exuberant Expectations versus Meticulous InvestigationRadiology2021Volume: 301Issue: 2pp. 485-486Survival and Toxicities after 90Y Transarterial Radioembolization of Metastatic Colorectal Cancer in the RESIN RegistryRadiology2022Volume: 305Issue: 1pp. 228-236Imaging Biomarkers of Tumor Response in Neuroendocrine Liver Metastases Treated with Transarterial Chemoembolization: Can Enhancing Tumor Burden of the Whole Liver Help Predict Patient Survival?Radiology2016Volume: 283Issue: 3pp. 883-894Prediction of Therapeutic Effect of Chemotherapy for NSCLC Using Dual-Input Perfusion CT Analysis: Comparison among Bevacizumab Treatment, Two-Agent Platinum-based Therapy without Bevacizumab, and Other Non-Bevacizumab Treatment GroupsRadiology2017Volume: 286Issue: 2pp. 685-695See More RSNA Education Exhibits Review of Different Underlying Causes of Life-Threatening HemoptysisDigital Posters2018Comprehensive Review of Hemoptysis: Imaging and TreatmentDigital Posters2018Hemoptysis: A Practical Guide to Understand Its Causes and TreatmentsDigital Posters2019 RSNA Case Collection Rasmussen aneurysmRSNA Case Collection2022Pulmonary pseudoaneurysmRSNA Case Collection2021Radioembolization of Liver Metastasis RSNA Case Collection2020 Vol. 3, No. 6 Metrics Altmetric Score PDF download