Selective pulmonary artery perfusion (SPAP) is a modality of regional chemotherapy first investigated in the 1950's. A number of studies in animal models documented pharmacokinetic superiority with high-dose local cytostatic drug concentrations when compared to intravenous administration. Blood flow occlusion of the pulmonary artery before or after drug injection results in further increase in local drug concentrations. Animal tumor models with sarcoma and coloncarcinoma confirm anti-tumour efficacy in cytostatic SPAP. In human investigations, feasibility and safety of chemotherapeutic SPAP in humans has been documented. Recent encouraging investigations of SPAP with gemcitabine and blood flow occlusion in a porcine model emphasize the need for further investigations in humans with pulmonary malignancies for safety and efficacy assessments.