Bronchoscopic intratumoral chemotherapy of lung cancer

Described in this review is a therapeutic procedure for localized chemotherapy of lung cancer by bronchoscopic intervention. This procedure involves the intratumoral injection of one or several conventional cytotoxic drugs directly into tumor tissue through a flexible bronchoscope by means of an ordinary needle-catheter, and is termed "endobronchial intratumoral chemotherapy" (EITC). Intratumoral (IT) chemotherapy should not be considered merely an ablation technique for treatment of endobronchial tumor bulk such as other ablative endoscopic procedures. EITC rather affords a significant specific chemotherapeutic effect on malignant cells through the localized action of cytotoxic drugs. Although superficially similar to ablative methods such as brachytherapy and photodynamic therapy, EITC provides the multiple benefits of rapid initial eradication of tumor burden inside the airway lumen plus intratumoral delivery of cytotoxic drugs as a loco-regional neoadjuvant therapeutic modality prior to irradiation or surgery. It is localized chemotherapy which differs from intravenous chemotherapy by the route of delivery and mode of action. The manifold advantages of the EITC intratumoral injection procedure include (1) precise delivery of cancer drugs to and within the tumor, (2) complete perfusion of the lesion, (3) dramatically higher intratumor drug concentrations than possible by systemic drug delivery, and (4) virtually none of the toxic side effects which normally occur with conventional systemic chemotherapy. In this comprehensive review of endobronchial intratumoral chemotherapy of lung cancer via bronchoscopic needle-catheter our objective is to describe the clinical procedure, the outcomes, and the advantages for this neoadjuvant therapeutic procedure.