Management of hemoptysis in patients with lung cancer

Gershman, Evgeni; Guthrie, Rachel; Swiatek, Kevin; Shojaee, Samira

doi:10.21037/atm.2019.04.91

Cited by 37 publications

(19 citation statements)

References 86 publications

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“…Compared with the clinical outcomes of BAE for benign diseases, those for lung malignancy are low (58.3%–89%); recurrence rates are also higher (20%–75%) [ 2 , 5 , 6 , 10 – 12 , 19 ]. Thus, BAE is considered a second-line option in lung cancer when bronchoscopy or conservative treatment is of limited efficacy [ 20 ]. Differences in the pathogenesis of haemoptysis may explain this discrepancy.…”

Section: Discussionmentioning

confidence: 99%

Comparison of n-butyl-2-cyanoacrylate and polyvinyl alcohol particles for bronchial artery embolisation in primary lung cancer: a retrospective cohort study

et al. 2022

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Background Bronchial artery embolisation (BAE) is an effective treatment option to control haemoptysis in primary lung cancer. However, no studies have investigated optimal embolisation material for BAE in lung cancer patients. Thus, this study aimed to compare the safety and efficacy of BAE performed using n-butyl-2-cyanoacrylate (NBCA) and polyvinyl alcohol (PVA) particles in primary lung cancer patients to determine which embolic material is better for patients with haemoptysis. Methods This retrospective study was approved by the institutional review board, and consent was waived. The rates of hemostasis, complications, procedure time, dose–area product, and haemoptysis-free survival were retrospectively compared between primary lung cancer (non-small cell [n = 111] and small cell [n = 11]) patients who underwent BAE using NBCA (n = 58) or PVA particles (n = 64) between January 2004 and December 2019. Predictors of recurrent haemoptysis were analysed using the Cox proportional hazard regression model. Results Among 122 patients (mean age, 66 ± 10 years; range 32–86 years; 103 men), more patients in the NBCA group (81.0%; 47 of 58) achieved complete hemostasis than did patients in the PVA group (53.1%; 34 of 64) (P = 0.002). No major complications were observed in either group. The procedure time (36.4 ± 21.6 vs. 56.3 ± 27.4 min, P < 0.001) was shorter, and the dose–area product (58.6 ± 64.0 vs. 233.5 ± 225.0 Gy*cm2, P < 0.001) was smaller in the NBCA group than in the PVA group. The median haemoptysis-free survival was 173.0 in the NBCA group compared with 20.0 days in the PVA group (P < 0.001). The PVA use (P < 0.001) and coagulopathy (P = 0.014) were independent predictors of shortened haemoptysis-free survival. Conclusion BAE using NBCA showed significantly superior initial hemostasis with longer haemoptysis-free survival, shorter procedure time, and reduced radiation dose than BAE using PVA particles. The PVA use and coagulopathy were independent predictors of recurrent haemoptysis. Trial registration: Retrospectively registered

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Section: Discussionmentioning

confidence: 99%

Comparison of n-butyl-2-cyanoacrylate and polyvinyl alcohol particles for bronchial artery embolisation in primary lung cancer: a retrospective cohort study

et al. 2022

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“…Hemoptysis is commonly associated with thoracic malignancies. Tumors within the chest can lead to hemoptysis in several ways, including neo-vascularization within the mass, tumor necrosis, erosion into the central airways and surrounding vessels, and cavitation of the mass (26). Squamous cell carcinoma, in particular, seems to be most associated with the risk of hemoptysis.…”

Section: Epidemiology and Etiologymentioning

confidence: 99%

Management of life-threatening hemoptysis in the ICU

Charya¹,

Holden²,

Pickering³

2021

J Thorac Dis

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Life-threatening hemoptysis is commonly encountered in the ICU and its management can be challenging even for experienced clinicians. Depending on the etiology and severity, one can tailor the treatment modality and therapeutic intervention(s). The grading of severity of hemoptysis varies greatly in the literature; however, unlike hemorrhage in other scenarios, small amounts of blood can significantly impair oxygenation and ventilation leading to cardiovascular collapse. Importantly, the initial evaluation and management should focus on airway and hemodynamic stabilization along with maintenance of oxygenation and ventilation. In this review, we discuss commonly encountered etiologies, vascular anatomy, diagnostic evaluation, and therapeutic interventions. We examine the evolving trends in etiologies of life-threating hemoptysis over the years. The role of flexible and rigid bronchoscopy as both a diagnostic and therapeutic modality is explored, as well as the use and indications of several bronchoscopic techniques, such as topical hemostatic agents, endobronchial tamponade, and tranexamic acid (TXA). In addition, we assess the use of multi-row detector computed tomography as the initial rapid diagnostic method of choice and its use in planning for definitive treatment. The efficacy and long-term results of bronchial artery embolization (BAE) are evaluated, as well as indications for surgical intervention. Furthermore, the importance of a multidisciplinary approach is emphasized. The necessary interplay between intensivists, consultative services, and radiologists is described in detail and an algorithmic management strategy incorporating the above is outlined. Given the complexity in management of life-threatening hemoptysis, this paper aims to summarize the available diagnostic and therapeutic methods and provide a standardized approach for the management of patients with this often difficult to treat condition.

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“…Bronchial artery embolization is usually the preferred option for hemoptysis, with a success rate of 60-90%. Transbronchial intervention techniques (including stenting) are also options (154).…”

Section: Interventional Treatment Of Hemoptysis In Patients With Lung Cancermentioning

confidence: 99%