A 32-year-old male patient was admitted with symptoms such as chest tightness, chest pain, cough and panic. Computed tomography (CT) had shown that the mediastinum and right lung occupied a space, measuring about 11 cm × 17 cm, with uneven enhancement (Fig. 1a). Then, etoposide and cisplatin chemotherapy were used for 5 cycles. After three months, the CT scan revealed that the tumor was slightly smaller than before, measuring about 10 cm × 14 cm, but uneven enhancement was still seen (Fig. 1b). Multidisciplinary consultation showed that the tumor was huge and close to the pericardium, so it was difficult to remove. Considering the abundant blood supply of the tumor, it was deemed feasible to perform surgical resection after transcatheter arterial chemoembolization.
Using a transfemoral approach, a 5-F Cobra (Cook Medical Products, Bloomington, IN, USA) catheter was used to examine the bronchial artery, internal thoracic artery and phrenic artery for angiography (Fig. 2). Then the responsible vessels were intubated with 2.7-F PROGREAT® microcatheter (Terumo Interventional Systems, Tokyo, Japan). Through the microcatheter, 40 mg of docetaxel and a vial of 300–500 µm diameter CalliSpheres microspheres (Suzhou Hengrui Callisyn Biomedical Co., Ltd., Suzhou, Jiangsu Province China) loaded with 100 mg of oxaliplatin were injected to occlude each tumor artery until angiographic tumor staining disappeared. Then, the 5-F vertebral catheter (Cook Medical Products, Bloomington, IN, USA) was used to intubate the right internal mammary artery, where the tumor staining area could be visualized by angiography. Embolization was subsequently performed with the above method. It must be noted that the embolic agent should be injected slowly to avoid nontargeted embolization. The patients were given symptomatic treatment after operation to reduce edema and prevent infection.
One month after embolization, CT scan showed a considerable reduction in tumor size and blood supply. After a further round of DEE-TACE consolidation treatment had been completed, CT scan showed a considerable reduction in tumor size (8.5 cm × 13 cm) and complete necrosis of the tumor (Fig. 1c). After the surgical consultation, the tumor load was significantly reduced, so it was decided to move forward with the tumor resection and right upper lobectomy. Postoperative pathology revealed a mediastinal neuroendocrine tumor along with chronic inflammation of the upper lobe of the right lung and interstitial fibrosis. One month after resection, CT scan showed no residual tumor. The life quality of the patient was significantly improved, without chest tightness, chest pain, or other symptoms. At 1-year of follow-up, he had no tumor recurrence.