Umur Anıl PEHLİVAN, Tuğsan BALLI, Kairgeldy AİKİMBAEV

Karaciğer dev hemanjiyomlarinin tedavisinde bleomisin ve lipiodol karışımı ile kemoembolizasyonun güvenilirliği ve etkinliği

Amaç: Bu retrospektif gözlemsel çalışmanın amacı, karaciğer dev hemanjiyomlarının tedavisinde uygulanan bleomisin ve lipiodol karışımı ile transarteryal kemoembolizasyon (TAKE) tedavisinin güvenilirliğini ve etkinliğini değerlendirmekti. Gereç ve Yöntem: Bu çalışmaya Ekim 2014 ile Ocak 2020 tarihleri arasında bleomisin ve lipiodol karışımı ile TAKE uygulanan ve takip edilen 24 dev hemanjiyomu olan ardışık 21 hasta dahil edilmiştir. Tüm hastaların işlem öncesi ve sonrası dev hemanjiyom boyutları, hacimleri, bası bulguları not edilmiştir.. Bulgular: Bu çalışmada tedavi uygulanmış toplam 24 hemanjiyomu olan 21 hasta (14’ü [%66.6] kadın) istatistiksel olarak değerlendirilmiştir. Hastaların medyan yaşı 47’dir (min-max: 35-69 yaş). Hastaların TAKE sonrası medyan takip süresi, 26.2 aydır (min-max: 5.5-48.5 ay). İki hasta dışında tüm hastalara tek seans TAKE uygulandı. Dev hemanjiyomların medyan boyutu, TAKE öncesi 96 mm (min-max: 41-210 mm), TAKE sonrası 61 mm’dir (min-max: 20-120 mm). Dev hemanjiyomların TAKE öncesi medyan hacmi 240.79 ml (min-max: 13.13-2628.62 ml); TAKE sonrası 61 ml’dir (min-max: 3.02-831.16 ml). Hem boyut hem de hacimsel azalma istatistiksel olarak anlamlı bulundu. Herhangi bir majör komplikasyon gözlemlenmedi Sonuç: Bleomisin ve lipiodol karışımı ile TAKE düşük komplikasyon oranı nedeniyle güvenilir bir yöntemdir. Dev hemanjiyomlarda anlamlı ölçüde küçülme sağlaması nedeniyle, etkin bir yöntemdir. Cerrahi tedavinin uygun olmadığı dev hemanjiyomlu hastalarda alternatif olabilir.

Anahtar Kelimeler:

Karaciğer, dev hemanjiyom, Bleomisin, Lipiodol, transarteryal kemoembolizasyon

Safety and efficacy of chemoembolization with mixture of bleomycin and lipiodol in the treatment of giant liver hemangiomas

Purpose: The aim of this retrospective observational study was to evaluate the safety and efficacy of transarterial chemoembolization (TACE) therapy with a mixture of bleomycin and lipiodol used in the treatment of giant liver hemangiomas. Materials and Methods: Twenty-one patients with a total of 24 giant liver hemangiomas treated with TACE using a mixture of bleomycin and lipiodol between October 2014 to January 2020 were included in this study. Dimension, volume, and compression findings prior to and after the procedure were recorded.. Results: Twenty-four hemangiomas in 21 patients (14 [66,6%] female) were statistically investigated. The median age was 47 years (min-max: 35-69 years). Post-TACE median follow-up was 26.2 months (min-max: 5.5-48.5 months). In all but two patients, a single session TACE was performed. The median dimension of giant hemangiomas was 96 mm (min-max: 41-120 mm) and 61 ml (min-max: 20-120 mm) before and after TACE respectively. Median volume was 240.79 ml (13.13-2628.62 ml) and 61 ml (3.02-831.16 ml) before and after TACE respectively. There was a statistically significant reduction in both dimension and volume. There was no major complication. Conclusion: Transarterial chemoembolization with a mixture of bleomycin and lipiodol is a safe method due to the low complication rate. Due to the fact that it significantly reduces the size of giant hemangiomas, it is an effective method. It may be an alternative in patients with giant hemangioma for whom surgical treatment is not appropriate.

Keywords:

Liver, giant hemangioma, Bleomycin, Lipiodol, transarterial chemoembolization,

PDF

___

1. Choi BY, Nguyen MH. The diagnosis and management of benign hepatic tumors. J Clin Gastroenterol. 2005;39:401-12.
2. Yehuda AG, Huvos AG, Fortner JG. Giant hemangiomas of the liver. Ann Surg. 1970;172:239-45.
3. Duxbury MS, Garden OJ. Giant haemangioma of the liver: Observation or resection? Dig Surg. 2010;27:7- 11.
4. Yamamoto T, Kawarada Y, Yano T, Noguchi T, Mizumoto R. Spontaneous rupture of hemangioma of the liver: Treatment with transcatheter hepatic arterial embolization. Am J Gastroenterol. 1991;86:1645-49.
5. Erdogan D, Busch OR, van Delden OM, Bennink RJ, ten Kate FJ, Gouma DJ, et al. Management of liver hemangiomas according to size and symptoms. J Gastroenterol Hepatol. 2007;22:1953-58.
6. Ribeiro MAF Jr, Papaiordanou, Gonçalves FJM, Chaib E. Spontaneous rupture of hepatic hemangiomas: A review of the literature. World J Hepatol. 2010;2:428-33.
7. Tsai CC, Yen TC, Tzen KY. The value of Tc-99m red blood cell SPECT in differentiating giant cavernous hemangioma of the liver from other liver solid masses. Clin Nuc Med. 2002;27:578-81.
8. Schnelldorfer T, Ware AL, Smoot R, Schleck CD, Harmsen WS, Nagorney DM. Management of giant hemangioma of the liver: Resection versus observation. J Am Coll Surg. 2010;211:724-30.
9. Bozkaya H, Çınar C, Ünalp ÖV, Parildar M, Oran İ. Unusual treatment of Kasabach-Merritt syndrome secondary to hepatic hemangioma: embolization with bleomycin. Wien Klin Wochenschr. 2015;127:488-90.
10. Smith AAH, Nelson M. High-output heart failure from a hepatic hemangioma with exertion-induced hypoxia. Am J Cardiol. 2016;117:157-58.
11. Özden İ, Emre A, Alper A, Tunaci M, Acarli K, Bilge O et al. Long-term results of surgery for liver hemangiomas. Arch Surg. 2000;135:978-81.
12. Terkivatan T, Vrijland WW, den Hoed PT, De Man RA, Hussain SM, Tilanus HW et al. Size of lesion is not a criterion for resection during management of giant liver haemangioma. Br J Surg. 2002;89:1240-44.
13. Özden İ, Poyanlı A, Önal Y, Demir AA, Hoş G, Acunaş B. Superselective transarterial chemoembolization as an alternative to surgery in symptomatic/enlarging liver hemangiomas. World J Surg. 2017;41:2796-2803.
14. Alper A, Ariogul O, Emre A, Uras A, Okten A. Treatment of liver hemangiomas by enucleation. Arch Surg. 1988;123:660-61.
15. Iwatsuki S, Starzl TE. Personal experience with 411 hepatic resections. Ann Surg. 1988;208:421-34.
16. Yamagata M, Kanematsu T, Matsumata T, Utsunomiya T, Ikeda Y, Sugimachi K. Management of haemangioma of the liver: Comparison of results between surgery and observation. Br J Surg. 1991;78:1223-25.
17. Brouwers MA, Peeters PM, de Jong KP, Haagsma EB, Klompmaker IJ, Bijleveld CM et al. Surgical treatment of giant haemangioma of the liver. Br J Surg. 1997;84:314-16.
18. Zeng Q, Li Y, Chen Y, Ouyang Y, He X, Zhang H. Gigantic cavernous hemangioma of the liver treated by intra-arterial embolization with pingyangmycinlipiodol emulsion: A multi-center study. Cardiovasc Intervent Radiol. 2004;27:481-485.
19. Bozkaya H, Cinar C, Besir FH, Parıldar M, Oran I. Minimally invasive treatment of giant haemangiomas of the liver: Embolisation with bleomycin. Cardiovasc Intervent Radiol. 2014;37:101-7.
20. Yuliang L, Jia Y, Li S, Wang W, Wang Z, Wang Y et al. Transarterial chemoembolization of giant liver haemangioma: A multi-center study with 836 cases. Cell Biochem Biophys. 2015;73:469-72.
21. Sun JH, Nie CH, Zhang YL, Zhou GH, Ai J, Zhou TY et al. Transcatheter arterial embolization alone for giant hepatic hemangioma. PLoS ONE. 2015;10:e0135158.
22. Akhlaghpoor S, Torkian P, Golzarian J. Transarterial bleomycin–lipiodol embolization (B/LE) for symptomatic giant hepatic hemangioma. Cardiovasc Intervent Radiol. 2018;41:1674-82.
23. Kirnap M, Boyvat F, Boyacioglu S Hilmioglu F, Moray G, Haberal M. The effect of bleomycin embolization on symptomatic improvement and hemangioma size among patients with giant liver hemangiomas. Int J Surg. 2018;12:12-16.
24. Flippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classicification of complications: The Cirse classification system. Cardiovasc Intervent Radiol. 2017;40:1141-1146.
25. Pietrabissa A, Giulianotti P, Campatelli A, Di Candio G, Farina F, Signori S et al. Management and followup of 78 giant haemangiomas of the liver. Br J Surg. 1996;83:915-18.
26. Demircan O, Demiryurek H, Yagmur O. Surgical approach to symptomatic giant cavernous hemangioma of the liver. Hepatogastroenterology. 2005;52:183-86.
27. Yedibela S, Alibek S, Müller V, Aydin U, Langheinrich M, Lohmüller C et al. Management of hemangioma of the liver: Surgical therapy or observation? World J Surg. 2013;37:1303-12.
28. Conter RL, Longmire WP. Recurrent hepatic hemangiomas. Possible association with estrogen therapy. Ann of Surg. 1988;207:115-19.
29. Althaus S, Ashdown B, Coldwell D, Helton WS, Freeny PC. Transcatheter arterial embolization of two symptomatic giant cavernous hemangiomas of the liver. Cardiovasc Intervent Radiol. 1996;19:364-67.
30. Srivastava DN, Gandhi D, Seith A, Pande GK, Sahni P. Transcatheter arterial embolization in the treatment of symptomatic cavernous hemangiomas of the liver: A prospective study. Abd Imaging. 2001;26:510-14.
31. Deutsch GS, Yeh KA, Bates WB, Tannehill WB. Embolization for management of hepatic hemangiomas. Am Sur. 2001;67:159-64.
32. Danza FM, De Franco A, Marino V, Fasanellia L, Coscarellab G, Rossi P et al. Percutaneous sclerosis of giant cavernous hepatic hemangioma: Preliminary report of two cases. International Congress Series. 2001;1083-87.
33. Park SY, Tak WY, Jung MK, Jeon SW, Cho CM, Kweon YO, et al. Symptomatic-enlarging hepatic hemangiomas are effectively treated by percutaneous ultrasonography-guided radiofrequency ablation. J Hepatol. 2011;54:559-65.
34. Sharpe EE, Dodd GD. Percutaneous radiofrequency ablation of symptomatic giant hepatic cavernous hemangiomas: Report of two cases and review of literature. J Vasc Intervent Radiol. 2012;23:971-75.
35. Ziemlewicz TJ, Wells SA, Lubner MA, Musat AI, Hinshaw JL, Cohn AR, et al. Microwave ablation of giant hepatic cavernous hemangiomas. Cardiovasc Intervent Radiol. 2014;37:1299-1305.
36. Yazdi NA, Dashti H, Batavani N, Borhani A, Shakiba M, Rokni Yazdi H. Percutaneous sclerotherapy for giant symptomatic liver hemangiomas: A pilot study. J Vasc Intervent Radiol. 2018;29:233-36.
37. Jin S, Shi XJ, Sun XD, Wang SY, Wang GY. Sclerosing cholangitis secondary to bleomyciniodinated embolization for liver hemangioma. World J Gastroenterol. 2014;20:17680-85.
38. Topaloğlu S, Oğuz Ş, Kalaycı O, Öztürk MH, Çalık A, Dinç H et al. Preoperative arterial embolization of large liver hemangiomas. Diagn Intervent Radiol. 2015;21:222-28.
39. de Baere T, Dufaux J, Roche A, Counnord JL, Berthault MF, Denys A et al. Circulatory alterations induced by intra-arterial injection of iodized oil and emulsions of iodized oil and doxorubicin: Experimental study. Radiology. 1995;194:165-70.
40. Favoulet P, Cercueil JP, Faure P, Osmak L, Isambert N, Beltramo JL et al. Increased cytotoxicity and stability of lipiodol-pirarubicin emulsion compared to classical doxorubicin-lipiodol: Potential advantage for chemoembolization of unresectable hepatocellular carcinoma. Anti-Cancer Drugs. 2001; 12:801-6.
41. Wu GC, Chan ED, Chou YC, Yu CY, Hsieh TY, Hsieh CB et al. Risk factors for the development of pulmonary oil embolism after transcatheter arterial chemoembolization of hepatic tumors. Anti-Cancer Drugs. 2014;25:976-81.
42. Hongfa Z, Obeidat K, Ouyang J, Roayaie S, Schwartz ME, Thung SN. Recurrent giant hemangiomas of liver: Report of two rare cases with literature review. World J Gastrointest Surg. 2012;4:262-66.