Transvenous pulmonary chemoembolization (TPCE) for palliative or neoadjuvant treatment of lung metastases.

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.

Intravascular Treatment Techniques for Locoregional Therapies of Lung Tumors. / Intravaskuläre Therapieverfahren zu lokoregionalen Therapien von Lungentumoren.

BACKGROUND: Lung cancer incidence has greatly increased over the past century. Moreover, the lung is the most common site of metastatic involvement. Despite improvements in the diagnosis and treatment of lung malignancies, patient prognosis is still unsatisfactory. Locoregional chemotherapeutic techniques for the treatment of lung malignancies are the current focus of research. The aim of this review article is to present different locoregional intravascular techniques and their treatment principles and to assess the pros and cons of each of them as a palliative and neoadjuvant treatment method in the treatment of lung malignancy. METHOD: The different methods for the treatment of malignant lung lesions such as isolated lung perfusion (ILP), selective pulmonary artery perfusion (SPAP), transpulmonary chemoembolization (TPCE), bronchial artery infusion (BAI), bronchioarterial chemoembolization (BACE), and intraarteriel chemoperfusion (IACP) are evaluated comparatively. RESULTS: Locoregional intravascular chemotherapy procedures are proving to be promising treatment options in the management of malignant lung tumors. In order to achieve optimal results, the locoregional technique should be used to achieve the highest possible uptake of the chemotherapeutic agent into the target tissue with rapid systemic clearance. CONCLUSION: Among the various treatment options for lung malignancies, TPCE is the best evaluated treatment concept. However, further studies are necessary to define the optimal treatment concept with the best clinical outcomes. KEY POINTS: · There are various intravascular chemotherapy methods for the treatment of lung malignancies.. · Transpulmonary chemoembolization (TPCE) is currently the most extensively evaluated treatment method for lung malignancies.. · Thermoablation after neoadjuvant chemoperfusion is a promising therapy for treating lung malignancies.. CITATION FORMAT: · Vogl TJ, Mekkawy A, Thabet DB. Intravascular Treatment Techniques for Locoregional Therapies of Lung Tumors. Fortschr Röntgenstr 2023; 195: 579 - 585.

Serial ultrasonographic monitoring of diaphragmatic and mid-upper arm muscle thickness in mechanically ventilated respiratory patients: A single-center observational study.

INTRODUCTION: Muscle monitoring during mechanical ventilation (MV) is gaining great interest nowadays; however, a proper monitoring tool is not well-established yet. OBJECTIVES: To assess the role of ultrasound in muscle monitoring during MV in respiratory patients. METHODS: Eligible 68 mechanically ventilated patients were consecutively enrolled. Serial ultrasound measurements of diaphragmatic thickness at the end of inspiration (Tdi) and mid-upper arm (MUA) muscle thickness were recorded every other day till weaning. Before discharge, functional status score (FSS) was assessed. RESULTS: Tdi decreased in 72.1%, did not change in 13.2% and increased in 14.7% of the patients. MUA muscle thickness decreased in 47.17% and did not change in others. Significant correlation between Tdi and MUA muscle thickness change was found (r = 0.404, P = 0.001); however, MUA muscle thickness change could not predict Tdi change (B = 0.067, P = 0.059). Diaphragmatic and MUA thickness change showed significant negative correlation with ICU stay (r = -0.260, -0.647, P = 0.032, <0.001) and MV duration (r = -0.335, -0.596, P = 0.005, <0.001), respectively. Weaning failure was significantly higher among patients with decreased Tdi (64.28%) and FSS was significantly lower in those with decreased MUA muscle thickness. US measurements of Tdi and MUA muscle thickness showed excellent intra-observer (ICC = 0.996, 0.999, P < 0.001) and inter-observer agreement (ICC = 0.992, 0.998, P < 0.001), respectively. CONCLUSION: Sonographic muscle monitoring during MV is promising. Changes in the diaphragmatic thickness during MV are common and weakly related to those of peripheral muscles. Early decreased muscle thickness heralds poor weaning and functional outcome.