Transpulmonary chemoembolization (TPCE) - Minimally invasive treatment of lung tumors | 2 sessions | Uniclinic Frankfurt, Germany

Transpulmonary chemoembolization (TPCE) is a technique that involves delivering chemotherapy directly to lung tumors with a higher concentration than traditional intravenous chemotherapy. This technique aims to reduce the toxicity that systemic chemotherapy can cause. TPCE can be an alternative treatment for patients with pulmonary metastases who have failed prior systemic chemotherapy or have postoperative recurrence. Chemoembolization has proven to be more effective than intravenous chemotherapy. The efficiency of chemoembolization and isolated lung perfusion were comparable. However, the advantage of chemoembolization over isolated lung perfusion is that it can be performed through the skin, making it less invasive than isolated lung perfusion, which requires a thoracotomy. In 2005, a study evaluating transpulmonary chemoembolization for lung metastases in vivo was presented for the first time. The study achieved a reduction in the volume of the metastases in 33% of cases. The aim of our study is to investigate how primary lung tumors respond to TPCE treatment and to identify any side effects associated with it. Course of treatmentDuring TPCE treatment, only one or a maximum of two lung lobe segments can be treated in a session. The treatment is carried out over two to eight sessions, with 4 weeks between each session. The procedure starts with administering local anesthesia using 1% mepivacaine. Then, a 7-French sheath is applied to the right femoral vein, and a 5-French Headhunter catheter is inserted into the pulmonary artery. The arterial vascular system of the half of the lung undergoing treatment is visualized using angiography. Then, the corresponding segmental artery is probed using a Headhunter catheter, and a balloon catheter with a diameter of 7mm and length of 110mm is placed in the selected segmental artery. The catheter tip is advanced into the subsegmental pulmonary arteries over a guide wire, depending on the size, location, and supply area of the arteries. After blocking the catheter, contrast-enhanced angiography is performed to rule out arteriovenous shunts. Next, 5 mg/m2 body surface (BSA) mitomycin (Medac, Hamburg), up to 10 ml Lipiodol (Guerbert, Sulzbach), and 200 to 450 mg microspheres (Spherex; Pharmacia and Upjohn, Erlangen, diameter: 20) are slowly added under fluoroscopy (70 µm) until the blood flow stops. Specific laboratory parameters, such as hemoglobin, bilirubin, creatinine levels, leukocyte and platelet counts, alanine and aspartate aminotransferase values, cholinesterase levels, and coagulation values, are checked before each treatment. Ten to 48 hours after the first treatment, native and contrast-enhanced computed tomography scans are performed, and this is repeated every month. After completion of sequential therapy, interval checks follow every 3 months. Follow-up care extends over a period of at least six months to two years. All images are compared with the previous ones to register changes in the size of the tumors.