The Role of Image-Guided Percutaneous and Transarterial Therapies in the Management of Lung Cancer

Learning Objectives: 1. To discuss and compare the various image-guided percutaneous thermal ablation therapies used in lung cancer management.
2. To review the pulmonary vasculature anatomy and the bronchial circulatory system in the context of transarterial therapies.
3. To discuss the several transarterial therapies, targeting the bronchial or pulmonary artery, used in lung cancer management.

Background: Lung cancer remains the leading cause of cancer mortality worldwide, with approximately 1.8 million deaths annually, despite advances in prevention and therapies. While surgery is the ideal treatment option for resectable lung cancer, not all patients are suitable for resection and a significant proportion develop recurrence. With the advent of lung cancer screening, more early-stage, locoregional tumors are being discovered, leading to the increased utility of various minimally invasive treatment options. Various national guidelines and societies have recommended and affirmed the use of thermal ablative modalities as a viable treatment option for lung cancer. Several transarterial therapies that have adapted from liver cancer management are also starting to be effectively used as well.

Clinical Findings/Procedure Details: Image-guided locoregional therapies play a crucial role in the management of patients with lung tumors. Percutaneous therapies include radiofrequency ablation, microwave ablation, and cryoablation, and are proven to be effective for early-stage or oligometastatic lung cancer. We describe the various percutaneous therapies and compare their efficacy and safety using best available evidence. In addition to percutaneous therapies, transarterial therapies include a set of catheter-based treatments to deliver embolic and/or chemotherapeutic agents directly to the arteries supplying tumors. Given the dual supply to the lung, arteries can be targeted while sparing adjacent lung parenchyma. We describe several transarterial methods used to target the pulmonary or bronchial artery with chemotherapy, embolization, or chemoembolization (with or without drug-eluting beads). Our exhibit also includes several unique cases illustrating these modalities.

Conclusion and/or Teaching Points: After viewing this exhibit, attendees will appreciate the various image-guided percutaneous and transarterial therapies that have proven to be highly promising for primary and metastatic lung cancer. Future clinical trials and multicenter large cohort studies will further optimize and validate these modalities’ role in lung cancer management.