Endovascular Management of Life-Threatening Hemoptysis in Primary Lung Cancer: A Retrospective Study

• Published in: Cardiovascular and interventional radiology Vol. 46; no. 7; pp. 891 - 900
• Main Authors: Le Tat, Thomas, Carlier, Robert, Zhang, Norbert, Bouchet, Antoine, Amar, Raphaël, Zhou, Jeffery, El Hajjam, Mostafa
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.07.2023; Springer Nature B.V
• Subjects: Acute Disease; Angiography; Arteries; Bronchial Arteries - diagnostic imaging; Cardiology; Cardiovascular system; Cavitation; Clinical Investigation; Complications; Embolisation (arterial); Embolization; Embolization, Therapeutic - methods; Endovascular Procedures - adverse effects; Health services; Hemoptysis; Hemoptysis - diagnostic imaging; Hemoptysis - etiology; Hemoptysis - therapy; Humans; Imaging; Implants; Ischemia; Lung cancer; Lung Neoplasms - therapy; Medical records; Medicine; Medicine & Public Health; Metastases; Microspheres; Neoplasm Recurrence, Local - therapy; Nuclear Medicine; Pancreatitis; Patients; Pulmonary arteries; Pulmonary Artery; Radiology; Rank tests; Retrospective Studies; Spinal cord; Survival; Thorax; Treatment Outcome; Tumors; Ultrasound; Bronchial artery; Embolization; Hemoptysis; Lung cancer
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-023-03488-w

Objective The aim of this study was to evaluate the efficacy and safety of endovascular treatment of hemoptysis caused by primary lung cancer. Methods We conducted a single-center retrospective study (2005–2021), including patients who underwent thoracic embolization for life-threatening hemoptysis complication of lung cancer. Exclusion criteria were hemoptysis caused by a benign lung tumor or by a lung metastasis of a primary non-lung tumor. Depending on the origin of the bleeding, determined by CT-angiography, systemic arteries were treated with microspheres or coils, and pulmonary arteries with coils, plugs or covered stents. Outcomes were assessed from patients' medical records in April 2022. Primary endpoints were clinical success at one month and at one year. Secondary endpoints were incidence of complications, 1 year overall survival, and relative risk of recurrence of hemoptysis. Survival was compared with a log-rank test. Results Sixty-two patients underwent 68 systemic artery embolizations and 14 pulmonary artery procedures. Clinical success defined as cessation of hemoptysis without any recurrence was 81% at one month and 74% at one year. Three major complications occurred: spinal cord ischemia, stroke, and acute pancreatitis. 5% of patient died from hemoptysis. One-year overall survival was 29% and was significantly higher in patients without hemoptysis recurrence when compared to patients with recurring hemoptysis ( p  =  0.021 ). In univariate analysis, recurrence of hemoptysis at one year was associated with massive hemoptysis (RR = 2.50; p  =  0.044 ) and with tumor cavitation (RR = 2.51; p  =  0.033 ). Conclusion Endovascular treatment for primary lung cancer-related hemoptysis is effective but not uneventful.