Bronchial Artery Embolization for the Management of Hemoptysis in Oncology Patients: Utility and Prognostic Factors

Abstract

To evaluate the utility of bronchial artery embolization (BAE) in the oncology population and determine prognostic factors. This is a retrospective review of 30 consecutive oncology patients (20 men, 10 women; mean age, 60 years) who were referred for BAE for the management of hemoptysis from 1992 to 2007. The amount of hemoptysis at initial embolization was massive (frank blood >300 mL per 24 hours) in 13 patients (43%), moderate (frank blood <300 mL per 24 hours) in 15 (50%), and trivial (blood-tinged sputum) in two (7%). Eighteen patients (60%) had a primary intrathoracic malignancy, seven (23%) had pulmonary metastases, and five (17%) had no evidence of malignant disease in the lung. The technical success rate, defined as the ability to selectively embolize the abnormal vessel, was 86% (32 of 37 procedures). Clinical response categories and complications were defined according to the guidelines established by the SIR Standards of Practice Committee. The major complication rate was 3%, including one case of spinal cord infarction. BAE provided symptom palliation with an immediate decrease or resolution of bleeding in 24 out of 27 patients (89%). The 30-day mortality rate for this cohort was 30%, and the median survival was 5.5 months. Survival was significantly better in patients with non-tumor-related hemoptysis than in those with tumor-related bleeding (P = .004). There was no significant difference in median survival between patients with massive hemoptysis and those with moderate/mild hemoptysis (P = .81), between patients with an emergent procedure and those with a non-emergent procedure (P = .39), and between patients who had previously undergone radiation therapy and those who had not (P = .4). BAE is safe and effective for the oncologic patient population. In patients with tumor-related hemoptysis, the prognosis remains poor; however, for the subset of oncology patients whose hemoptysis is not related to malignant disease in the lung, the survival is significantly better.