
Embolization or chemoembolization could be of use for unresectable lung metastases. Also, this regional therapy may offer new hope for those sarcoma patients who have lung metastases resistant to combination systemic chemotherapy, either for downgrading of tumors prior to surgical resection, or for palliation.  Embolization or chemoembolization is not curative by itself, and additional therapy is required to eradicate residual disease. 

Blood is delivered to tumors by means of arteries.  Anticancer drugs mixed with some 'embolic' particles such as polyvinyl alcohol and gelatin powder can be injected selectively in the arteries that feed tumors. This causes clotting in those arteries, and infarcts tumors [kills tumor cells by removing their blood supply]. Additionally the anticancer drugs work on the tumor. Their work is enhanced by their not being quickly washed away by the blood circulation [which has been clotted or slowed]. Radio-opaque contrast media can also be present in the mixture, and the progress of the mixture monitored radiologically. 

Chemoembolization causes massive shrinkage due to ischemia [loss of blood supply], and increases the local drug intensity and drug exposure. 

The feeding artery is reached by advancing a catheter from the femoral or other artery. The catheter can be advanced into the artery that feeds the majority of the tumor blood supply, and the embolization material is injected, followed by the chemotherapy regimen previously decided upon, until the feeder artery no longer transports liquid. 

Side Effects and Complications are the obvious ones: local trauma, artery rupture, infection, abscess, reaction to the injected materials, the side effects due to the injected materials, fever, pain, misdirected drainage of the injected material resulting in damage to other structures. 

For more information, Search Pubmed for &&url 


<b>Annotated Medical Journal Articles</b>


J Surg Res. 2002 Oct;107(2):159-66. 
<b>Temporary unilateral microembolization of the lung-a new approach to regional chemotherapy for pulmonary metastases.</b> 
Schneider P, Foitzik T, Pohlen U, Golder W, Buhr HJ. 
Department of Surgery, University Hospital Benjamin Franklin, Free University of Berlin, Hindenburgdamm 30, Germany. 

BACKGROUND: Except in patients with resectable disease, treatment of pulmonary metastases is still disappointing. Regional chemotherapy may be a suitable method for delivering more effective doses to regionally confined tumors while minimizing systemic toxicity. We propose an unilateral chemoembolization of the lung applicable by endovascular method. 
MATERIALS AND METHODS: An unilateral microembolization of the lung with degradable starch microspheres (DSM) alone (group 1) and combined with carboplatin (group 2) was performed on Sprague-Dawley rats (n = 12). Microcirculatory parameters were studied by in vivo videomicroscopy and radiological pattern on pulmonary angiogram. 
RESULTS: After injection of DSM,... [there was] neither altered permeability nor pulmonary edema. Pulmonary angiogram confirmed patency of the central pulmonary artery. 
CONCLUSION: For the first time unilateral microembolization of the lung could be established in an experimental model. By injection of DSM, reversible embolization on arteriolar and capillary level could be demonstrated without occlusion of the main branches of the pulmonary arteries. Alveolar-capillary membrane disorder as symptom of early toxicity could not be detected even with additional application of carboplatin. 
&&url PMID: 12429171 


Clin Cancer Res. 2002 Jul;8(7):2463-8. 
<b>Chemoembolization of the lung improves tumor control in a rat model.</b>
Schneider P, Kampfer S, Loddenkemper C, Foitzik T, Buhr HJ. 
Department of Surgery, Benjamin Franklin Medical Center, Freie Universitat Berlin, Hindenburgdamm 30, D-12200 Berlin, Germany. 

PURPOSE: The novel method of organ-specific drug application we present here is unilateral chemoembolization of the lung by injecting the pulmonary artery with degradable starch microspheres and cytotoxic drugs to improve tumor control in lung metastases. 
EXPERIMENTAL DESIGN: In a solitary metastasis rat model (CC531 adenocarcinoma), we studied the clinical and histological tumor response as well as subacute toxicity of the lung. Fourteen days after tumor induction, animals were randomized into five groups. Groups I and II served as controls. Group III received carboplatin i.v. (45 mg/kg). Isolated lung perfusion with buffered starch solution and carboplatin (15 mg/kg) was installed in group IV. Chemoembolization with carboplatin (15 mg/kg) was performed in group V. 
RESULTS: Seven days later, the difference in the tumor volume before and after treatment was +422 mm(3) (+/-226) in group I, +697 mm(3) (+/-423) in group II, +70 mm(3) (+/-31) in group III, -8 mm(3) (+/-17) in group IV, and -17 mm(3) (+/-16) in group V (P < 0.05 groups IV and V versus groups I, II, and III). No pleural spread was observed in groups IV and V. Histologically, the area of tumor necrosis was largest in group IV. Mild alveolar cell hyperplasia, pulmonary edema, and hemorrhage without subacute fibrotic changes were noted in all groups. CONCLUSION: This is the first study to perform chemoembolization of the lung. Compared with i.v. therapy, chemoembolization was more effective without serious toxicity. Its efficacy was comparable with that of isolated lung perfusion but less stressful for a possible clinical application. 
&&url PMID: 12114454


Cancer. 1984 Dec 1;54(11 Suppl):2751-65. 
<b>Infusion-embolization. </b>
Wallace S, Charnsangavej C, Carrasco CH, Bechtel W. 

Transcatheter intra-arterial therapy for the cancer patient encompasses infusion of chemotherapy and embolization. Intra-arterial infusion of chemotherapeutic agents has been resurrected because of the availability of new drugs, combinations of drugs, and the capability of percutaneous selective catheter placement. Intra-arterial infusion has been effective in patients with carcinomas of the liver, bladder, prostate, uterus, ovary, and lung and in bone and soft tissue sarcomas, melanomas, and tumors of the brain. Embolization of the arterial supply, creating ischemia of the neoplasm, has been employed in the therapeutic management of patients with primary and secondary neoplasms of the liver, kidney, and bone. The median survival of 100 patients with neoplasms of the liver from the time of hepatic artery embolization was 11.5 months. In 100 patients with pulmonary metastases from carcinoma of the kidney, 28 experienced a response to renal artery embolization, a therapeutic delay of 4 to 7 days, nephrectomy, and Depo-Provera (medroxyprogesterone). Seven of 12 patients with giant cell tumor of the pelvis and lumbar spine responded to arterial embolization after all other therapy failed. Chemoembolization, the combination of arterial infusion of chemotherapy and embolization, can be accomplished by the use of microencapsulated agents, liposomes, and particulate emboli with drugs. This approach integrates the advantages of infusion and occlusion, and has considerable potential. Intra-arterial immunotherapy has been initiated with bacillus Calmette-Guerin (BCG) administration into renal neoplasms in patients with metastatic disease. 
&&url PMID: 6093984 