Palliative Procedures in Lung Cancer

Abstract

Palliative care aims to optimize comfort and function when cure is not possible. Image-guided interventions for palliative treatment of lung cancer is aimed at local control of advanced disease in the affected lung, adjacent mediastinal structures, or distant metastatic sites. These procedures include endovascular therapy for superior vena cava syndrome, bronchial artery embolization for hemoptysis associated with lung cancer, and ablation of osseous metastasis. Pathophysiology, clinical presentation, indications of these palliative treatments, procedural techniques, complications, and possible future interventions are discussed in this article.

Keywords

palliative treatment - superior vena cava (SVC) syndrome - hemoptysis - osseous metastasis - interventional radiology

• References

• 1 Yim CD, Sane SS, Bjarnason H. Superior vena cava stenting. Radiol Clin North Am 2000; 38 (2) 409-424
• 2 Markman M. Diagnosis and management of superior vena cava syndrome. Cleve Clin J Med 1999; 66 (1) 59-61
• 3 Schindler N, Vogelzang RL. Superior vena cava syndrome. Experience with endovascular stents and surgical therapy. Surg Clin North Am 1999; 79 (3) 683-694 , xi
• 4 Fagedet D, Thony F, Timsit JF , et al. Endovascular treatment of malignant superior vena cava syndrome: results and predictive factors of clinical efficacy. Cardiovasc Intervent Radiol 2013; 36 (1) 140-149
• 5 Lanciego C, Pangua C, Chacón JI , et al. Endovascular stenting as the first step in the overall management of malignant superior vena cava syndrome. AJR Am J Roentgenol 2009; 193 (2) 549-558
• 6 Kim YI, Kim KS, Ko YC , et al. Endovascular stenting as a first choice for the palliation of superior vena cava syndrome. J Korean Med Sci 2004; 19 (4) 519-522
• 7 Charnsangavej C, Carrasco CH, Wallace S , et al. Stenosis of the vena cava: preliminary assessment of treatment with expandable metallic stents. Radiology 1986; 161 (2) 295-298
• 8 Nicholson AA, Ettles DF, Arnold A, Greenstone M, Dyet JF. Treatment of malignant superior vena cava obstruction: metal stents or radiation therapy. J Vasc Interv Radiol 1997; 8 (5) 781-788
• 9 Nguyen NP, Borok TL, Welsh J, Vinh-Hung V. Safety and effectiveness of vascular endoprosthesis for malignant superior vena cava syndrome. Thorax 2009; 64 (2) 174-178
• 10 Ganeshan A, Hon LQ, Warakaulle DR, Morgan R, Uberoi R. Superior vena caval stenting for SVC obstruction: current status. Eur J Radiol 2009; 71 (2) 343-349
• 11 Smayra T, Otal P, Chabbert V , et al. Long-term results of endovascular stent placement in the superior caval venous system. Cardiovasc Intervent Radiol 2001; 24 (6) 388-394
• 12 Urruticoechea A, Mesia R, Dominguez J , et al. Treatment of malignant superior vena cava syndrome by endovascular stent insertion. Experience on 52 patients with lung cancer. Cancer 2004; 43: 209-214
• 13 Kee ST, Kinoshita L, Razavi MK, Nyman UR, Semba CP, Dake MD. Superior vena cava syndrome: treatment with catheter-directed thrombolysis and endovascular stent placement. Radiology 1998; 206 (1) 187-193
• 14 de Gregorio Ariza MA, Gamboa P, Gimeno MJ , et al. Percutaneous treatment of superior vena cava syndrome using metallic stents. Eur Radiol 2003; 13 (4) 853-862
• 15 Sato KT. Palliative endovascular interventions. J Vasc Interv Radiol 2004; 15: 149-152
• 16 Warren P, Burke C. Endovascular management of chronic upper extremity deep vein thrombosis and superior vena cava syndrome. Semin Intervent Radiol 2011; 28 (1) 32-38
• 17 Desai KR, Chen RI. Endovascular therapy for palliative care of cancer patients. Semin Intervent Radiol 2007; 24 (4) 382-390
• 18 Wilson E, Lyn E, Lynn A, Khan S. Radiological stenting provides effective palliation in malignant central venous obstruction. Clin Oncol (R Coll Radiol) 2002; 14 (3) 228-232
• 19 Irving JD, Dondelinger RF, Reidy JF , et al. Gianturco self-expanding stents: clinical experience in the vena cava and large veins. Cardiovasc Intervent Radiol 1992; 15 (5) 328-333
• 20 Shah R, Sabanathan S, Lowe RA, Mearns AJ. Stenting in malignant obstruction of superior vena cava. J Thorac Cardiovasc Surg 1996; 112 (2) 335-340
• 21 Mauro MA, Burke CT, Jaques PF. Transcatheter bronchial artery embolization for inflammation (hemoptysis). In: Baum S, Pentecost MJ, , eds. Abrams' Angiography Interventional Radiology. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006: 909-919
• 22 Cancer facts and figures 2012. Available at: www.cancer.org/research/cancerfactsfigures/acspc-031941 . Accessed December 2012
• 23 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 (6) 722-729
• 24 Rémy J, Arnaud A, Fardou H, Giraud R, Voisin C. Treatment of hemoptysis by embolization of bronchial arteries. Radiology 1977; 122 (1) 33-37
• 25 Hirshberg B, Biran I, Glazer M, Kramer MR. Hemoptysis: etiology, evaluation, and outcome in a tertiary referral hospital. Chest 1997; 112 (2) 440-444
• 26 Saumench J, Escarrabill J, Padró L, Montañá J, Clariana A, Cantó A. Value of fiberoptic bronchoscopy and angiography for diagnosis of the bleeding site in hemoptysis. Ann Thorac Surg 1989; 48 (2) 272-274
• 27 Mal H, Rullon I, Mellot F , et al. Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis. Chest 1999; 115 (4) 996-1001
• 28 Wong ML, Szkup P, Hopley MJ. Percutaneous embolotherapy for life-threatening hemoptysis. Chest 2002; 121 (1) 95-102
• 29 Park HS, Kim YI, Kim HY, Zo JI, 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 (4) 638-643
• 30 Portenoy RK, Miransky J, Thaler HT , et al. Pain in ambulatory patients with lung or colon cancer. Prevalence, characteristics, and effect. Cancer 1992; 70 (6) 1616-1624
• 31 Kurup AN, Callstrom MR. Ablation of skeletal metastases: current status. J Vasc Interv Radiol 2010; 21 (8, Suppl): S242-S250
• 32 Callstrom MR, Dupuy DE, Solomon SB , et al. Percutaneous image-guided cryoablation of painful metastases involving bone: Multicenter trial. Cancer 2013; 119 (5) 1033-1041
• 33 Kojima H, Tanigawa N, Kariya S, Komemushi A, Shomura Y, Sawada S. Clinical assessment of percutaneous radiofrequency ablation for painful metastatic bone tumors. Cardiovasc Intervent Radiol 2006; 29 (6) 1022-1026
• 34 Callstrom MR, Charboneau JW, Goetz MP , et al. Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem. Skeletal Radiol 2006; 35 (1) 1-15
• 35 Dupuy DE, Liu D, Hartfeil D , et al. Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial. Cancer 2010; 116 (4) 989-997
• 36 Simon CJ, Dupuy DE, Mayo-Smith WW. Microwave ablation: principles and applications. Radiographics 2005; 25 (Suppl. 01) S69-S83