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Tumor expectoration following drug-eluting bead bronchial artery chemoembolization for advanced non-small cell lung cancer

Year: 2026

Type: article

Abstract: Drug-eluting bead bronchial artery chemoembolization (DEB-BACE) has been investigated as a locoregional salvage treatment for advanced non-small cell lung cancer (NSCLC). It may be considered for treatment-refractory or symptomatic central tumors. We retrospectively describe case of three patients with centrally located, treatment-refractory NSCLC who underwent DEB-BACE. All three subsequently expectorated soft-tissue material. Clinical features, procedures, imaging, pathology, and outcomes were reviewed. Potential bronchial and non-bronchial systemic tumor-feeding arteries were assessed using contrast-enhanced computed tomography and selective digital subtraction angiography (DSA). Lobaplatin was infused intra-arterially. Embolization was then performed with 300 to 500 μm epirubicin-loaded Bead microspheres. The procedural endpoint was marked reduction of tumor blush with stasis or near-stasis. One patient had SMARCA4-deficient NSCLC. Two had squamous cell carcinoma. Soft-tissue expectoration occurred 3 days to 2 weeks after DEB-BACE. Histopathology confirmed carcinoma with extensive necrosis in Cases 1 and 2. Pathological confirmation was unavailable in Case 3. Case 1 achieved a durable partial response during repeated DEB-BACE and continued sintilimab treatment. The tumor decreased from 94 mm × 55 mm to 22 mm × 14 mm at 13 months and remained stable at 29 months. Case 2 developed tumor expectoration 3 days after treatment. Bronchial patency was subsequently restored. The patient died 10 months after diagnosis. Case 3 developed recurrent hemoptysis and underwent emergency hemostatic bronchial artery embolization. The patient subsequently expectorated a soft-tissue mass and died from progressive pulmonary infection 14 months after diagnosis. Tumor expectoration may represent treatment-associated necrosis after DEB-BACE. Careful assessment of vascular anatomy, bleeding risk, infection, and non-target embolization risk is essential.

Source: Quantitative Imaging in Medicine and Surgery

DOI: 10.21037/qims-2026-1506

Authors: Yi Deng, Yanqing Le, Jing Li, Rongde Xu, Wei Cui

Institutions: Guangdong Academy of Medical Sciences, Second Xiangya Hospital of Central South University, Guangdong Provincial People's Hospital, Southern Medical University

Language: English

Topic: Lung Cancer Diagnosis and Treatment

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7223211146

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