Transvenous pulmonary chemoembolization (TPCE) for palliative or neoadjuvant treatment of lung metastases.

PURPOSE: To retrospectively evaluate tumor response, local tumor control, and patient survival after the treatment of pulmonary metastases using transpulmonary chemoembolization (TPCE) in palliative and neoadjuvant intent. MATERIALS AND METHODS: One hundred forty-three patients (mean age 56.7 ± 13.4 years) underwent repetitive TPCE (mean number of sessions 5.8 ± 2.9) between June 2005 and April 2017 for the treatment of unresectable lung metastases, not responding to systemic chemotherapy. Patients had predominant lung metastases with bilateral lung involvement in 80.4% of the cases. Regional delivery of the chemotherapeutic agents was performed through selective catheterization of the tumor-supplying pulmonary arteries with subsequent injection of iodized oil and microspheres. Patients, who underwent subsequent ablation (n = 51), either for all lesions (complete) or dominant lesions (incomplete), constituted the neoadjuvant group, and those who underwent TPCE alone represented the palliative treatment intent (n = 92). The response was assessed according to the revised Response Evaluation Criteria in Solid Tumors (RECIST). RESULTS: Partial response was achieved in 11.9% (n = 17), stable disease in 66.4% (n = 95), and progressive disease in 21.7% (n = 31). The mean survival time and time to progression were 24.5 ± 1.7 and 7.5 ± 0.5 months, respectively. The mean survival time was shorter for the palliative group (19.7 ± 2), compared to the neoadjuvant group (30.1 ± 2.6 months). The use of TPCE alone or with incomplete ablation had a significantly increased hazard of death of 4.6- (p = 0.002) and 3.1-fold (p = 0.027), respectively, in comparison with TPCE with subsequent complete ablation. CONCLUSION: TPCE has the potential to improve local tumor control and to prolong survival with a neoadjuvant potential when combined with ablation therapy. KEY POINTS: • Transpulmonary chemoembolization (TPCE) is a locoregional technique for delivering chemotherapy in higher intratumoral concentrations and with reduced systemic toxicity. • TPCE can be an alternative treatment for patients with pulmonary metastases who failed prior systemic chemotherapy or with post-operative recurrence. • The current retrospective study revealed that TPCE is a feasible treatment option for patients with unrespectable lung secondaries in both palliative and neoadjuvant intent and has the potential of improving local control and prolonging survival.

Selenium status in patients with aspirin-induced asthma.

BACKGROUND: Platelets are involved in the pathogenesis of aspirin-induced asthma (AIA). AIA patients suffer from an active disease despite avoidance of aspirin, and it has been suggested that administration of aspirin to these patients increases the generation of immediate oxygen products of arachidonic acid, 12-hydroperoxyeicosatetraenoic acid (12-HPETE), in their platelets. 12-HPETE further activates the 5-lipoxygenase of leukotriene B4-producing inflammatory macrophages precipitating an acute asthmatic attack. Glutathione peroxidase (GPX) has the antioxidant capacity to reduce 12-HPETE, and thus modulate the arachidonic acid metabolic cascade. There is evidence that selenium (Se) nutrition can influence asthma but Se status in AIA patients has not received much attention. METHODS: We measured Se concentrations and GPX activities in platelets and plasma from 13 patients with AIA. Age- and sex-matched healthy individuals served as the control group. RESULTS: Patients with AIA had significantly higher median platelet Se concentration (102 ng/mg platelet protein) when compared with controls (49 ng/mg platelet protein, P = 0.003). Plasma Se concentrations in patients with AIA and controls were not significantly different (P = 0.59). Median platelet GPX activity was significantly higher in patients with AIA (102.7 mU/mg platelet protein) than in controls (66 mU/mg protein) (P = 0.05). The patient and control groups when combined showed weak, but significant correlation between platelet Se concentration and platelet GPX activity (r = 0.44; P = 0.03). CONCLUSION: It is proposed that the higher platelet Se concentration observed in AIA patients contributed to the higher platelet GPX activity seen in these patients. Such an enhanced antioxidant defence system might represent an adaptive response to protect against increasing free radical production by inflammatory cells in AIA and help decelerate ongoing respiratory hypersensitivity.