You may have heard of the treatment “cut off the food and starve the tumor”, is this a rumor or is it true? In fact, it is not possible to “starve” a tumor to death by dieting, but it is possible to necrotize it by cutting off the blood supply to the tumor, which is called vascular intervention.
Specifically, a catheter is inserted into the tumor’s blood supply artery from the artery at the base of the patient’s thigh, guided by an angiogram, and drugs are injected locally to kill the tumor; then an embolic agent is given to embolize the tumor’s main blood supply artery, blocking the tumor’s blood supply and causing it to become ischemic and necrotic.
This treatment is widely used in liver cancer, but less frequently in lung cancer.
Which lung cancer patients might be considered?
The key to successful interventional therapy is finding the main blood vessels supplying the tumor and performing chemotherapy and embolization. Lung cancer tissue is often supplied by two vascular systems, the bronchial artery and the pulmonary artery, and most interventions only embolize the bronchial artery, which cannot completely block the blood supply to the tumor and makes it difficult to cause ischemic necrosis of the lung cancer.
At present, neither the authoritative lung cancer guidelines in the United States nor in China include it as a standard therapy, and it is only used in cases where local treatment such as surgery or radiotherapy cannot be performed and systemic treatment cannot be done, especially for lung cancer patients with hemoptysis who can do both local chemotherapy and vascular embolization to stop the hemorrhage during vascular intervention.
Local injections of chemotherapeutic agents are basically similar to systemic chemotherapeutic agents and are usually combined with different types of drugs. Platinum-based, non-small cell lung cancer is combined with 5-fluorouracil (5-FU), doxorubicin (ADM), or pirarubicin (THP), and small cell lung cancer is combined with etoposide (VP16).
To improve outcomes, physicians may consider a “two-pronged” approach, combining bronchial artery perfusion with pulmonary artery perfusion or percutaneous pulmonary puncture intervention.
What are the possible adverse effects? How can physicians respond?
Adverse reactions to vascular interventions for lung cancer can be divided into side effects from chemotherapy drugs and side effects from interventional procedures.
The side effects of chemotherapy are similar to systemic chemotherapy, mainly bone marrow suppression such as decreased white blood cells and platelets, liver and kidney function impairment, nausea and vomiting. These reactions are milder than systemic chemotherapy, and the vast majority of patients generally recover completely with some palliative drugs.
The most serious side effect of interventional procedures is spinal cord injury, which manifests as numbness in the limbs and incontinence. This may be due to the fact that the bronchial artery shares a common branch with the spinal artery, and embolization leads to ischemic necrosis of the embolized spinal artery. Once this occurs, doctors will give aggressive treatment with drugs such as dehydration and vasodilators, but it may still lead to paralysis.
Co-reviewed by: Guangdong Provincial People’s Hospital Guangdong Lung Cancer Institute Dr. Xie Liang, deputy chief physician Dr. Dong Song, Dr. Tang Wenfang