Drug-Eluting Beads Bronchial Arterial Chemoembolization in Treating Relapsed/Refractory Small Cell Lung Cancer Patients: Results from a Pilot Study

Figures & data

Table 1 Clinical Features of SCLC Patients

Clinical Features	SCLC Patients (N=11)
Age (years)
Mean±SD	62.8±7.2
Range	49–71
Gender, No. (%)
Male	9 (81.8)
Female	2 (18.2)
History of smoking, No. (%)
No	2 (18.2)
Yes	9 (81.8)
ECOG score, No. (%)
1	7 (63.6)
2	4 (36.4)
Lesion location, No. (%)
Left	6 (54.5)
Right	5 (45.5)
Preoperative NSE level (ng/mL)
Median (IQR)	80.3 (35.7–172.6)
Range	17.2–196.8
Preoperative ProGRP level (pg/mL)
Median (IQR)	445.0 (186.2–910.6)
Range	86.7–1123.7

Abbreviations: SCLC, small cell lung cancer; SD, standard deviation; ECOG, Eastern Cooperative Oncology Group; NSE, neuron-specific enolase; IQR, interquartile range; ProGRP, progastrin-releasing peptide.

Table 2 Detailed Data of Each SCLC Patient

No.	Age (Years)	Gender	History of Smoking	ECOG Score	Lesion Location	TNM Stage	Treatment Response			Disease Progression	PFS (Months)	Survival Status	OS (Months)
							M1	M2	M6
1	70	Male	Yes	2	Left	T4N3M1c, IVB	PD	Dead	Dead	Yes	1.0	Dead	2.0
2	52	Female	No	1	Right	T4N2M1a, IVA	PR	CR	PR	Yes	8.0	Survival	13.0
3	61	Male	Yes	2	Left	T3N2M1a, IVA	SD	SD	SD	Yes	4.5	Dead	11.0
4	66	Male	Yes	1	Right	T4N3M1a, IVA	PR	PR	PD	Yes	5.0	Dead	10.0
5	62	Male	Yes	1	Left	T4N3M1c, IVB	PR	PR	SD	Yes	5.2	Survival	9.0
6	67	Female	No	2	Left	T2bN2M0, IIIA	PR	SD	PD	Yes	3.0	Dead	7.0
7	71	Male	Yes	2	Right	T3N3M1c, IVB	SD	SD	PD	Yes	3.4	Dead	6.7
8	62	Male	Yes	1	Left	T3N3M0, IIIB	PR	PR	PR	Yes	6.9	Dead	9.0
9	61	Male	Yes	1	Right	T3N2M0, IIIB	PR	CR	CR	Yes	9.2	Survival	11.4
10	70	Male	Yes	1	Right	T4N2M1a, IVA	PR	PR	PR	Yes	6.3	Dead	8.8
11	49	Male	Yes	1	Left	T4N2M1c, IVB	SD	SD	PD	Yes	4.4	Dead	6.5

Abbreviations: SCLC, small cell lung cancer; ECOG, Eastern Cooperative Oncology Group; M1, 1 month after operation; M2, 2 months after operation; M6, 6 months after operation; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease; PFS, progression-free survival; OS, overall survival.

Table 3 Treatment Response

Time Interval	Treatment Response, No. (%)				ORR	DCR
	CR	PR	SD	PD/Death
1st month	0 (0.0)	7 (63.6)	3 (27.3)	1 (9.1)/0 (0.0)	7 (63.6)	10 (90.9)
2nd month	2 (18.2)	4 (36.4)	4 (36.4)	0 (0.0)/1 (9.1)	6 (54.5)	10 (90.9)
6th month	1 (9.1)	3 (27.3)	2 (18.2)	4 (36.4)/1 (9.1)	4 (36.4)	6 (54.5)

Abbreviations: CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease; ORR, objective response rate; DCR, disease control rate.

Figure 1 Decrease of tumor marker levels post DEB-BACE treatment. The NSE level (A) and ProGRP level (B) at preoperation, 1st month, 2nd month and 6th month post DEB-BACE treatment in relapsed/refractory SCLC patients.

Abbreviations: DEB-BACE, drug-eluting beads bronchial arterial chemoembolization; NSE, neuron-specific enolase, ProGRP, progastrin-releasing peptide; SCLC, small cell lung cancer; IQR, interquartile range.

Table 4 QLQ-C30 Score Before and at 2 Months After Treatment

Items	QLQ-C30 Score, Mean±SD		P value
	Before Treatment	Two Months After Treatment
General health status	43.5±9.8	52.5±9.1	<0.001
Functional domains
Social function	50.1±9.2	62.2±8.7	<0.001
Emotional function	54.8±6.6	75.5±6.0	<0.001
Cognitive function	63.7±6.4	75.2±6.2	<0.001
Role function	63.5±6.8	76.8±6.4	<0.001
Physical function	59.9±9.7	70.3±11.0	<0.001
Symptom domains
Nausea and vomiting	52.2±9.0	42.8±6.8	<0.001
Pain	26.8±5.6	14.0±2.5	<0.001
Fatigue	45.5±11.7	32.5±9.2	<0.001
Single domains
Diarrhea	42.1±6.4	34.9±5.1	<0.001
Constipation	40.2±10.7	33.4±10.1	<0.001
Loss of appetite	42.6±8.7	31.8±9.4	<0.001
Insomnia	25.6±5.3	20.4±3.7	<0.001
Shortness of breath	21.6±6.4	11.5±1.8	<0.001
Financial difficulty	45.4±6.0	44.9±7.9	0.844

Abbreviations: QLQ-C30, Quality of Life Questionnaire-Core 30; SD, standard deviation.

Table 5 Cox’s Regression Analysis of Factors Related to PFS and OS

Items	Multivariate Cox’s Regression Analysis (Forward Stepwise)
	Beta	S.E.	Wald	P value	HR (95% CI)
PFS
ECOG score (2 vs 1)	3.775	1.461	6.676	0.010	43.609 (2.488–764.377)
Preoperative NSE (≥5ULN vs <5ULN)	2.412	1.130	4.558	0.033	11.159 (1.219–102.172)
OS
Age (≥65 years vs <65 years)	2.608	1.052	6.149	0.013	13.576 (1.727–106.699)
Lesion location (left vs right)	1.826	0.917	3.965	0.046	6.211 (1.029–37.489)

Abbreviations: PFS, progression-free survival; OS, overall survival; HR, hazard ratio; CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; NSE, neuron-specific enolase; ULN, upper limit of normal.

Figure 2 PFS and OS. The median values of PFS (A) and OS (B) in total patients, and the correlations of PFS (C) as well as OS (D) with age.

Abbreviations: PFS, progression-free survival; OS, overall survival; 95% CI, 95% confidence interval.

Figure 3 Angiography and chest CT images of a SCLC patient. The images of angiography in the lung during DEB-BACE (A–C), CT image of the reduction of lesion after chemotherapy in the left lung (D), CT image showing a progression of the lesion after chemotherapy (E), and the CT image showing reduction of lesion after DEB-BACE treatment (F).

Abbreviations: CT, computed tomography; DEB-BACE, drug-eluting beads bronchial arterial chemoembolization; SCLC, small cell lung cancer.