SELECTIVE BRONCHIAL ARTERY CHEMOINFUSION IN NSCLC: CURRENT STATE OF REGIONAL THERAPY AND ITS ROLE IN MULTIMODAL...

Regional intra-arterial delivery of cytotoxic drugs into bronchial arteries (bronchial artery infusion - BAI; bronchial arterial chemoembolization - BACE; drug-eluting bead BACE - DEB-BACE) aims to maximize local tumor exposure while minimizing systemic toxicity. Recent single-center series suggest potential for symptom control, local tumor downstaging and conversion to resectability in locally advanced NSCLC, but evidence remains heterogeneous.

To systematically review and critically appraise the clinical and methodological literature (2015-2025) on selective bronchial artery chemoinfusion (BAI, BACE, DEB-BACE) for locally advanced NSCLC, focusing on anatomical/technical prerequisites, pharmacokinetic rationale, oncologic efficacy (RECIST response, conversion to resectability, PFS, OS) and safety.

A targeted literature search of PubMed/MEDLINE (supplemented with PMC, Scopus and Cochrane checks) was conducted for publications from 1 January 2015 to 1 December 2025. Primary clinical studies (prospective/retrospective cohorts), case series and systematic reviews reporting outcomes after BAI/BACE/DEB-BACE in NSCLC were included. Data extraction addressed cohort characteristics, technical parameters, objective response (RECIST 1.1), conversion to surgery, survival outcomes, and complications. The review followed PRISMA 2020 guidelines. Quality was assessed using adapted Newcastle-Ottawa Scale and JBI checklists. Due to methodological heterogeneity, a narrative synthesis with subgrouping by technique and clinical context was performed.

Available evidence is largely retrospective and single-center, with heterogeneous technical protocols. DEB-BACE series (notably with CalliSpheres®) report favorable local control and objective responses (ORR up to ~50-60% in selected series), symptomatic relief (including hemostasis), and occasional conversion to radical resection, with acceptable safety and low rates of severe systemic toxicity. Comparative and combination studies (DEB-BACE±microwave ablation; DEB-BACE±PD-1 inhibitors) show encouraging signals for prolonged PFS/OS and improved local control but are limited by nonrandomized designs. Major complications are uncommon when superselective approaches and vascular mapping are applied. Quality assessment revealed moderate risk of bias in most studies (57.1%), with only 21.4% low risk.

BAI/DEB-BACE are promising regional strategies for selected patients with locally advanced or refractory NSCLC - especially for central, hypervascular tumors and for palliation of hemoptysis - and may be integrated into multimodal protocols in investigational settings. High-quality randomized, multi-center trials and procedural standardization are required to define their role relative to current systemic and combined modality treatments.