Skip to main content
SpringerLink
Log in

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

  • Clinical Investigation
  • Embolisation (arterial)
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

BAE:

Bronchial artery embolization

BMI:

Body-mass index

CIRSE:

Cardiovascular and Interventional Radiological Society of Europe

COPD:

Chronic obstructive pulmonary disease

CT:

Computed tomography

IASLC:

International Association for the Study of Lung Cancer

ICAE:

Intercostal artery embolization

IMAE:

Internal mammary artery embolization

NSCLC:

Non-small cell lung cancer

PAE:

Pulmonary artery embolization

PE:

Pulmonary embolism

SCLC:

Small cell lung cancer

WHO:

World Health Organization

References

  1. Walter FM, Rubin G, Bankhead C, Morris HC, Hall N, Mills K, et al. Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study. Br J Cancer. 2015;112(Suppl 1):S6-13. https://doi.org/10.1038/bjc.2015.30.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gershman E, Guthrie R, Swiatek K, Shojaee S. Management of hemoptysis in patients with lung cancer. Ann Transl Med. 2019;7:358. https://doi.org/10.21037/atm.2019.04.91.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Charya AV, Holden VK, Pickering EM. Management of life-threatening hemoptysis in the ICU. J Thorac Dis. 2021;13:5139–58. https://doi.org/10.21037/jtd-19-3991.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Almeida J, Leal C, Figueiredo L. Evaluation of the bronchial arteries: normal findings, hypertrophy and embolization in patients with hemoptysis. Insights Imaging. 2020;11:70. https://doi.org/10.1186/s13244-020-00877-4.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chun J-Y, Morgan R, Belli A-M. Radiological management of hemoptysis: a comprehensive review of diagnostic imaging and bronchial arterial embolization. Cardiovasc Interv Radiol. 2010;33:240–50. https://doi.org/10.1007/s00270-009-9788-z.

    Article  Google Scholar 

  6. Syha R, Benz T, Hetzel J, Spengler W, Kohlhäufl MJ, Gatidis S, et al. Bronchial artery embolization in hemoptysis: 10-year survival and recurrence-free survival in benign and malignant etiologies: a retrospective study. Rofo. 2016;188:1061–6. https://doi.org/10.1055/s-0042-112227.

    Article  CAS  PubMed  Google Scholar 

  7. Fartoukh M, Khoshnood B, Parrot A, Khalil A, Carette M-F, Stoclin A, et al. Early prediction of in-hospital mortality of patients with hemoptysis: an approach to defining severe hemoptysis. Respiration. 2012;83:106–14. https://doi.org/10.1159/000331501.

    Article  PubMed  Google Scholar 

  8. Xu S, Guan L-J, Shi B-Q, Tan Y-S, Zhang X-J. Recurrent hemoptysis after bronchial artery embolization: prediction using a nomogram and artificial neural network model. AJR Am J Roentgenol. 2020;215:1490–8. https://doi.org/10.2214/AJR.20.22775.

    Article  PubMed  Google Scholar 

  9. Frood R, Karthik S, Mirsadraee S, Clifton I, Flood K, McPherson SJ. Bronchial artery embolisation for massive haemoptysis: immediate and long-term outcomes-a retrospective study. Pulm Ther. 2020;6:107–17. https://doi.org/10.1007/s41030-020-00112-x.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chen J, Chen L-A, Liang Z-X, Li C-S, Tian Q, Yang Z, et al. Immediate and long-term results of bronchial artery embolization for hemoptysis due to benign versus malignant pulmonary diseases. Am J Med Sci. 2014;348:204–9. https://doi.org/10.1097/MAJ.0000000000000226.

    Article  PubMed  Google Scholar 

  11. Wang GR, Ensor JE, Gupta S, Hicks ME, Tam AL. Bronchial artery embolization for the management of hemoptysis in oncology patients: utility and prognostic factors. J Vasc Interv Radiol. 2009;20:722–9. https://doi.org/10.1016/j.jvir.2009.02.016.

    Article  PubMed  Google Scholar 

  12. Hu P, Wang G, Cao H, Ma H, Sui P, Du J. Haemoptysis as a prognostic factor in lung adenocarcinoma after curative resection. Br J Cancer. 2013;109:1609–17. https://doi.org/10.1038/bjc.2013.485.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Han K, Yoon KW, Kim JH, Kim GM. Bronchial artery embolization for hemoptysis in primary lung cancer: a retrospective review of 84 patients. J Vasc Interv Radiol. 2019;30:428–34. https://doi.org/10.1016/j.jvir.2018.08.022.

    Article  PubMed  Google Scholar 

  14. Garcia-Olivé I, Sanz-Santos J, Centeno C, Andreo F, Muñoz-Ferrer A, Serra P, et al. Results of bronchial artery embolization for the treatment of hemoptysis caused by neoplasm. J Vasc Interv Radiol. 2014;25:221–8. https://doi.org/10.1016/j.jvir.2013.09.017.

    Article  PubMed  Google Scholar 

  15. Fujita T, Tanabe M, Moritani K, Matsunaga N, Matsumoto T. Immediate and late outcomes of bronchial and systemic artery embolization for palliative treatment of patients with nonsmall-cell lung cancer having hemoptysis. Am J Hosp Palliat Care. 2014;31:602–7. https://doi.org/10.1177/1049909113499442.

    Article  PubMed  Google Scholar 

  16. Park HS, Kim YI, Kim HY, Zo J-I, Lee JH, Lee JS. Bronchial artery and systemic artery embolization in the management of primary lung cancer patients with hemoptysis. Cardiovasc Intervent Radiol. 2007;30:638–43. https://doi.org/10.1007/s00270-007-9034-5.

    Article  PubMed  Google Scholar 

  17. Marcelin C, Soussan J, Desmots F, Gaubert J-Y, Vidal V, Bartoli JM, et al. Outcomes of pulmonary artery embolization and stent graft placement for the treatment of hemoptysis caused by lung tumors. J Vasc Interv Radiol. 2018;29:975–80. https://doi.org/10.1016/j.jvir.2018.01.773.

    Article  PubMed  Google Scholar 

  18. Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WEE, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (Eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11:39–51. https://doi.org/10.1016/j.jtho.2015.09.009.

    Article  PubMed  Google Scholar 

  19. Marquis KM, Raptis CA, Rajput MZ, Steinbrecher KL, Henry TS, Rossi SE, et al. CT for evaluation of hemoptysis. Radiographics. 2021;41:742–61. https://doi.org/10.1148/rg.2021200150.

    Article  PubMed  Google Scholar 

  20. Kettenbach J, Ittrich H, Gaubert JY, Gebauer B, Vos JA. CIRSE standards of practice on bronchial artery embolisation. Cardiovasc Interv Radiol. 2022;45:721–32. https://doi.org/10.1007/s00270-022-03127-w.

    Article  Google Scholar 

  21. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Interv Radiol. 2017;40:1141–6. https://doi.org/10.1007/s00270-017-1703-4.

    Article  CAS  Google Scholar 

  22. Panda A, Bhalla AS, Goyal A. Bronchial artery embolization in hemoptysis: a systematic review. Diagn Interv Radiol. 2017;23:307–17. https://doi.org/10.5152/dir.2017.16454.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Befera NT, Ronald J, Kim CY, Smith TP. Spinal arterial blood supply does not arise from the bronchial arteries: a detailed analysis of angiographic studies performed for hemoptysis. J Vasc Interv Radiol. 2019;30:1736–42. https://doi.org/10.1016/j.jvir.2019.07.033.

    Article  PubMed  Google Scholar 

  24. Gailloud P. Spinal vascular anatomy. Neuroimaging Clin N Am. 2019;29:615–33. https://doi.org/10.1016/j.nic.2019.07.007.

    Article  PubMed  Google Scholar 

  25. Zhang Q, Li J, He G, Tang J, Zhang G. Utility of intra-procedural cone-beam computed tomography imaging for the determination of the artery of Adamkiewicz suspected by angiography during transarterial embolization for hemoptysis. Diagn Interv Radiol. 2023. https://doi.org/10.4274/dir.2022.221646.

    Article  PubMed  Google Scholar 

  26. Razazi K, Parrot A, Khalil A, Djibre M, Gounant V, Assouad J, et al. Severe haemoptysis in patients with nonsmall cell lung carcinoma. Eur Respir J. 2015;45:756–64. https://doi.org/10.1183/09031936.00010114.

    Article  PubMed  Google Scholar 

  27. Francisci S, Minicozzi P, Pierannunzio D, Ardanaz E, Eberle A, Grimsrud TK, et al. Survival patterns in lung and pleural cancer in Europe 1999–2007: results from the EUROCARE-5 study. Eur J Cancer. 2015;51:2242–53. https://doi.org/10.1016/j.ejca.2015.07.033.

    Article  PubMed  Google Scholar 

Download references

Funding

This study was not supported by any funding.

Author information

Authors and Affiliations

  1. Imaging Department, Ambroise Paré Hospital (AP-HP), 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France

    Thomas Le Tat, Robert Carlier, Norbert Zhang, Antoine Bouchet, Raphaël Amar, Jeffery Zhou & Mostafa El Hajjam

Authors
  1. Thomas Le Tat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert Carlier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Norbert Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antoine Bouchet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raphaël Amar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jeffery Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mostafa El Hajjam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas Le Tat.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by our Institutional Review Board.

Human or Animal Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed Consent

For this type of study informed consent is not required.

Consent for Publication

For this type of study consent for publication is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Le Tat, T., Carlier, R., Zhang, N. et al. Endovascular Management of Life-Threatening Hemoptysis in Primary Lung Cancer: A Retrospective Study. Cardiovasc Intervent Radiol 46, 891–900 (2023). https://doi.org/10.1007/s00270-023-03488-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-023-03488-w

Keywords

Search

Navigation