Transarterial Embolization for the Management of Emergent Hemoptysis in Patients With Primary and Metastatic Lung Tumors

Objectives

To evaluate the role of systemic arterial embolization in patients with primary and metastatic lung tumors presenting with hemoptysis requiring emergent management.

Patients and Methods

This retrospective single-center study evaluated patients undergoing transarterial embolization for emergent hemoptysis. Endpoints included technical success, clinical success and overall survival. Clinical success was divided into partial or complete, and defined as absence (complete) or subtotal (partial) reduction in frequency and/or volume of hemoptysis in the first 24-hours following embolization. Predictive factors for clinical outcomes were evaluated using univariate analysis. Adverse events were graded according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0.

Results

Thirty-seven patients were identified, including 21/37 (56.8%) patients with primary lung cancer. Clinical success was achieved in 31/37 (83.8%) patients. Median overall survival was 18 days (95% CI, 10-95). Median hemoptysis-free survival was 270 days (95% CI 7 to not reached). No significant predictors of hemoptysis-free survival were identified. Prior chemotherapy (HR 2.69, 95% CI, 1.08-6.67; P = .03) was associated with poorer overall survival. History of primary lung tumor (vs. metastatic tumor) was associated with improved overall survival (HR 0.45, 95% CI, 0.21-0.95; P = 0.04). No serious adverse events (CTCAE Grade ≥ 3) were found to be directly attributable to the embolization.

Conclusion

Hemoptysis requiring emergent management in patients with lung malignancy carries a poor prognosis. Transarterial embolization is feasible, safe and may be an effective management option, although further research is warranted to identify which patients are likely to derive the greatest benefit.