Bronchial Artery Embolization in Hemoptysis: 10-Year Survival and Recurrence-Free Survival in Benign and Malignant Etiologies – A Retrospective Study

Abstract

Purpose: The aim of the study was to evaluate safety, effectiveness, recurrence rate and 10-year survival after bronchial artery embolization (BAE) in benign and malignant etiologies.

Methods: The retrospective study includes 100 BAE procedures in 88 patients. Underlying disease was classified as benign (n = 67) and malignant (n = 21) etiologies. Immediate bleeding control and procedure safety were evaluated in all patients. In 51 (58 %) patients, follow-up data with a median follow-up time of 1015 days (range, 494 to 3727 days) were acquired to assess overall survival, time-to-recurrence of bleeding and recurrence-free survival, using Kaplan-Maier estimates to compare differences between both subgroups.

Results: Immediate bleeding control was achieved after 96/100 procedures (96 %), with a minor complication rate of 5.0 %. No major complications occurred. The overall survival was 74 % after 1 year and 59 % after 5 years and 10 years. There was a significant difference in survival between the malignant and benign groups (p < 0.0001). Survival was 90 %, 80 % and 76 % at 1 year, 3 years and 10 years, respectively, in the benign group and 18 % and 0 % at 1 year and 3 years, respectively in the malignant group. The median time to recurrence of bleeding and recurrence-free survival were 239 days and 94 % after 1 year and 87 % after 10 years in the benign group, compared to 66 days and 34 % after 1 year and 0 % after 3 years in the malignant group (p = 0.0107).

Conclusion: BAE is a safe and highly effective treatment option in hemoptysis. However, the recurrence rate and survival are highly dependent on the underlying disease.

Key Points:

• BAE is a safe and highly effective treatment option in hemoptysis.

• Recurrence rate and survival are strongly dependent on the underlying disease with significantly impaired results in patients with malignant diseases.

• Coil embolization is an effective BAE treatment method. Nevertheless, it should be mentioned, that reinterventions can be impeded, if embolization is performed in the proximal part of bronchial arteries.

Citation Format:

• Syha R, Benz T, Hetzel J et al. Bronchial Artery Embolization in Hemoptysis: 10-Year Survival and Recurrence-Free Survival in Benign and Malignant Etiologies – A Retrospective Study. Fortschr Röntgenstr 2016; 188: 1061 – 1066

Zusammenfassung

Hintergrund: Ziel der Studie war die Evaluation der Bronchialarterienembolisation (BAE) in der Behandlung von Hämoptysen benigner oder maligner Genese bezüglich Sicherheit, Effektivität, Rezidivrate und der 10-Jahres-Überlebensrate.

Material und Methoden: Die retrospektive Studie analysiert 100 BAE Prozeduren bei 88 Patienten. Die Grunderkrankung wurde als benigne (n = 67) oder maligne (n = 21) klassifiziert. Der technische Erfolg (sofortige Blutungskontrolle) und die Sicherheit der Prozedur wurde bei allen Patienten analysiert. Bei 51 Patienten (58 %) konnten Follow-up Daten mit einem medianen Follow-up von 1015 Tagen (range, 494 to 3727 Tagen) akquiriert werden (overall-survival, time-to-recurrence, recurrence-free survival), um Unterschiede zwischen den Subgruppen mittels Kaplan-Maier-Kurven zu analysieren.

Ergebnisse: Eine sofortige Blutungskontrolle konnte bei 96/100 Prozeduren erzielt werden. Die Minor-Komplikationsrate betrug 5,0 % bei keinen Major-Komplikationen. Das Overall-survival betrug 74 % nach einem Jahr und 59 % nach 5 und 10 Jahren mit signifikanten Unterschieden zwischen der malignen und benignen Subgruppe (p < 0,0001). Das Overall-survival war 90 % (1 Jahr), 80 % (3 Jahre) und 76 % (10 Jahre) in der benignen und 18 % (1 Jahr) und 0 % (3 Jahre) in der malignen Subgruppe. Die mittlere time-to-recurrence und das recurrence-free-survival war 239 Tage und 94 % nach 1 Jahr und 87 % nach 10 Jahren (benigne Subgruppe) verglichen zu 66 Tagen und 34 % nach 1 Jahr und 0 % nach 3 Jahren (maligne Subgruppe) (p = 0,0107).

Schlussfolgerung: Die BAE ist eine sichere und effektive Therapieoption bei Hämoptysen. Der Langzeiterfolg ist jedoch abhängig von der Grunderkrankung.

Kernaussagen:

• Die BAE ist eine sichere und effektive Therapieoption bei Hämoptysen.

• Die Rezidivrate und das Überleben nach BAE ist abhängig von der Grunderkrankung mit signifikant schlechteren Ergebnissen bei maligner Ätiologie.

• Die Coilembolisation ist eine effektive Möglichkeit der BAE. Jedoch muss darauf hingewiesen werden, dass eine inital zentrale Embolisation der Bronchialarterie zu vermeiden ist, um Reinterventionen zu ermöglichen.

Key words

broncial artery embolization - subgroup analysis - benign etiology - malignant etiology

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