Chemoembolization of lung metastases
A 45 year old patient with breast cancer and lung metastases, came under our observation sent by oncologists. After a previous thermoablation of metastatic lesion to the middle lobe of the right lung, and after several line therapies, the disease is progressive and no longer responsive to chemotherapy with the appearance of new metastatic lesions.
Various comorbidities preclude surgery. Axial CT image of the right Lung showed metastases from breast cancer in the apex of the upper lobe.
A palliative pulmonary chemoembolization will be performed (Pulmonary precision TACE).
We performed the right subclavian venipuncture under ultrasound and fluoroscopic guidance and we proceeded with the trans-cardiac catheterization of the left main pulmonary artery with a Coaxial Technique.
We used an armed guide catheter and an hydrophilic guidewire to reach the left pulmonary artery, pass through the superior vena cava, right atrium, tricuspid valve, right ventricle and pulmonary valve. We chose a Direxion™ Fathom™ system to perform the superselective catheterization of the right pulmonary artery branch relating to the metastatic lesion.
Through the Direxion™ microcatether we performed the diagnostic angiography and we obtained HQ images provided by Direxion™ high flow rates and high burst pressure. This helped us to identify the vessels involved more quickly and confirm the high vascularization of metastatic lung lesions already noted on CT.
The 300-500 micron microspheres were chosen to perform the selective chemoembolization of the vessels (Pulmonary precision TACE).
We injected 8 ml of microspheres mixed to chemotherapy until complete vascular stasis.
At the end of the procedure we performed additional diagnostic angiography which demonstrated the complete devascularization of lung lesions.
After one day of hospitalization at our O.U., the patient went home with indication to perform a CT scan after one month eventually to proceed with new treatment of Pulmonary precision TACE.
Dr. Cosmo Damiano Gadaleta – Chief of Radiology Department & Interventional Radiologist - "IRCCS Istituto dei Tumori Giovanni Paolo II" – Bari
Dr. Vito Fazio - Dr. Francesco Macina - Dr. Dario de Ceglia - Interventional Radiologists - "IRCCS Istituto dei Tumori Giovanni Paolo II" – Bari