title: Unresectable lung malignancy: combination therapy with segmental pulmonary arterial chemoembolization with drug-eluting microspheres and radiofrequency ablation in 17 patients.
abstract: OBJECTIVE
  To evaluate the feasibility, safety, and effectiveness of combining segmental pulmonary arterial chemoembolization (SPACE) and percutaneous radiofrequency (RF) ablation in patients with unresectable lung neoplasms or patients with resectable neoplasms who refused surgery and to compare the local tumor progression (LTP) rate with that in previous studies of RF ablation alone.
  
  
  METHODS
  After institutional review board approval and informed consent, 17 patients with primary and metastatic lung cancer were enrolled in this prospective study. Between January 2008 and February 2011, 20 nodules (median diameter, 3.0 cm; range, 2.0-5.0 cm) were treated during 19 sessions. Antineoplastic agents loaded on 50-100-µm microspheres were selectively infused into specific pulmonary arteries. Percutaneous computed tomography (CT)-guided RF ablation of lung nodules was performed 48 hours after SPACE. Follow-up consisted of enhanced CT 48 hours after combination treatment was completed, after 30 days, and every 3 months thereafter. Fluorine 18 fluorodeoxyglucose positron emission tomography was performed 3 months after combination therapy and then every 6 months. The t test was used to compare groups.
  
  
  RESULTS
  Technical success was achieved in 100% of cases. Ventilation-lung single photon emission computed tomography showed a wide area without ventilation in the lung parenchyma treated with SPACE. The LTP rate was 21% (three of 14 nodules) in 3-5-cm-diameter tumors and 0% (zero of six nodules) in tumors of 3 cm or smaller in diameter. Complete response was achieved in 65% (11 of 17) of patients at minimum follow-up of 6 months. Overall, treatment was well tolerated. Major complications were pneumothorax in five of 19 sessions (26%) and one bronchopleural fistula (one of 19, 5%). No treatment-related changes in general lung function were noted.
  
  
  CONCLUSIONS
  Combination therapy with RF ablation after SPACE to treat unresectable lung tumors is technically feasible, safe, and effective and may represent an advantage over RF ablation alone.
authors.affiliation: Interventional Radiology and Medical Oncology Unit, National Cancer Research Centre Istituto Tumori Giovanni Paolo II Bari, Viale Orazio Flacco 65, 70124 Bari, Italy. c.gadaleta@oncologico.bari.it
authors.forename: Cosmo D
authors.initials: CD
authors.lastname: Gadaleta
authors.forename: Luigi
authors.initials: L
authors.lastname: Solbiati
authors.forename: Vittorio
authors.initials: V
authors.lastname: Mattioli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rubini
authors.forename: Vito
authors.initials: V
authors.lastname: Fazio
authors.forename: Veronica
authors.initials: V
authors.lastname: Goffredo
authors.forename: Gianluca
authors.initials: G
authors.lastname: Vinciarelli
authors.forename: Gennaro
authors.initials: G
authors.lastname: Gadaleta-Caldarola
authors.forename: Eugenio
authors.initials: E
authors.lastname: Canniello
authors.forename: Francesco
authors.initials: F
authors.lastname: Armenise
authors.forename: Luigi
authors.initials: L
authors.lastname: D'Aluisio
authors.forename: Angela
authors.initials: A
authors.lastname: Gaudiano
authors.forename: Girolamo
authors.initials: G
authors.lastname: Ranieri
authors.forename: S Nahum
authors.initials: SN
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D017115:Catheter Ablation / Q000379:methods*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D018450:Disease Progression; D004317:Doxorubicin / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D004317:Doxorubicin; D002945:Cisplatin