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Narayanan G, Spano A, Gentile NT, Shnayder-Adams MM, Gurusamy V, Levi DM, Wilky BA, Mora RA, Noman R, Peddu P, Dijkstra M. Irreversible Electroporation as a Valid Treatment Option for Hepatic Epithelioid Hemangioendothelioma: An International Multicenter Experience. Cardiovasc Intervent Radiol 2024; 47:883-890. [PMID: 38844684 PMCID: PMC11239779 DOI: 10.1007/s00270-024-03770-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/22/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE Hepatic epithelioid hemangioendothelioma (HEHE) is a rare tumor with currently no established standard of care. This international multicenter retrospective study assesses the use of percutaneous irreversible electroporation (IRE) as an ablative tool to treat HEHE and provides a clinical overview of the current management and role of IRE in HEHE treatment. MATERIAL AND METHODS Between 2017 and 2023, 14 patients with 47 HEHE tumors were treated with percutaneous IRE using CT-scan guidance in 23 procedures. Baseline patient and tumor characteristics were evaluated. Primary outcome measures included safety and effectiveness, analyzed using Common Terminology Criteria for Adverse Events (CTCAE) and treatment response by mRECIST criteria. Secondary outcome measures included technical success, post-treatment tumor sizes and length of hospital stay. Technical success was defined as complete ablation with an adequate ablative margin (intentional tumor free ablation margin > 5 mm). RESULTS IRE treatment resulted in technical success in all tumors. Following a median follow-up of 15 months, 30 tumors demonstrated a complete response according to mRECIST criteria. The average tumor size pre-treatment was 25.8 mm, accompanied by an average reduction in tumor size by 7.5 mm. In 38 out of 47 tumors, there was no evidence of local recurrence. In nine tumors, residual tumor was present. There were no cases of progressive disease. Median length of hospital stay was one day. Only one grade 3 CTCAE event occurred, a pneumothorax requiring chest tube placement. CONCLUSION The current study provides evidence that IRE is a safe and efficacious minimally invasive treatment option for HEHE.
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Affiliation(s)
- Govindarajan Narayanan
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Anthony Spano
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Nicole T Gentile
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Michelle M Shnayder-Adams
- Division of Vascular and Interventional Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Varshana Gurusamy
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA
| | - David M Levi
- Division of Abdominal Transplant Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC, USA
| | | | - Ronald A Mora
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Raihan Noman
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Praveen Peddu
- Department of Radiology, King's College Hospital NHS Trust, London, UK
| | - Madelon Dijkstra
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA.
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Cancer Center Amsterdam, Amsterdam, The Netherlands.
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Feng L, Li M, Huang Z, Xu M. Hepatic epithelioid hemangioendothelioma-a single-institution experience with 51 cases. Front Oncol 2023; 13:1236134. [PMID: 37601682 PMCID: PMC10435877 DOI: 10.3389/fonc.2023.1236134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives The aim of the present study was to describe the experience at a single institution in the management of hepatic epithelioid hemangioendothelioma (HEHE). Methods We included 51 patients with histologically confirmed HEHE. We performed log-rank (Cox-Mantel) survival analyses using Kaplan-Meier methods to test differences in survival between patients in different groups. Univariate Cox regression analyses and multivariate proportional hazards regression model were carried out to identify independent prognostic factors. Results Different imaging modalities were used to diagnose HEHE with various presentations. Liver resection (LR), liver transplantation (LT), systemic treatment (ST), and surveillance had been used in our study. A significant difference was noted between the LR group and the surveillance group with respect to mean survival (p = 0.006), as was in the LR group and the ST group (p = 0.036), and in surgical approach (LR and LT) and nonsurgical approach (ST and surveillance) (p = 0.008). The mean survival between the ST group and the surveillance group was not significantly different (p = 0.851). LR (p = 0.010) and surgical approach (p = 0.014) were favorable predictors of outcome, while macrovascular invasion (MaVI) (p = 0.037), lung metastasis (p = 0.040), and surveillance (p = 0.033) were poor prognostic factors in univariate analysis. Multivariate analysis showed that LR (p = 0.010) and surgical approach (p = 0.014) were independently associated with good OS, while surveillance (p = 0.033) was independently associated with poor OS. After adjusting for confounding factors, patients in the LR group have much better OS than those in the surveillance group (p = 0.013). However, there was no significant difference in OS between the LR group and ST group (p = 0.254), as was in the ST group and the surveillance group (p = 0.857). Conclusions The definitive diagnosis of HEHE was dependent on histopathology, and it was not possible to make a specific diagnosis without biopsy because the radiological findings were similar to those in some hepatic malignancies. ST was not recommended for patients who were not candidates for surgical approaches, and surgical approaches should be warranted regardless of disease stage. The retrospective nature and the small size of the data limited the generalizability of the study, designing a worldwide database that contains all data about patients with HEHE independent of their therapy, which was highly recommended.
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Affiliation(s)
- Lei Feng
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Manjie Li
- Radiology Department of West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhuo Huang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingqing Xu
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Dobrindt EM, Öllinger R, Flörcken A, Märdian S, Schmelzle M, Lurje G, Pratschke J, Schoening W. Primäre Lebersarkome – Empfehlungen zur chirurgischen Therapie. Zentralbl Chir 2022; 148:165-179. [PMID: 35211924 DOI: 10.1055/a-1728-6939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Eva Maria Dobrindt
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Robert Öllinger
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Anne Flörcken
- Medizinische Klinik m.S. Hämatologie, Onkologie und Tumorimmunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Sven Märdian
- Zentrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Moritz Schmelzle
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Georg Lurje
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Johann Pratschke
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Wenzel Schoening
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Kou K, Chen YG, Zhou JP, Sun XD, Sun DW, Li SX, Lv GY. Hepatic epithelioid hemangioendothelioma: Update on diagnosis and therapy. World J Clin Cases 2020; 8:3978-3987. [PMID: 33024754 PMCID: PMC7520791 DOI: 10.12998/wjcc.v8.i18.3978] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/12/2020] [Accepted: 08/21/2020] [Indexed: 02/05/2023] Open
Abstract
With an estimated incidence of only 1-2 cases in every 1 million people, hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular endothelial cell tumor occurring in the liver and consisting of epithelioid and histiocyte-like vascular endothelial cells in mucus or a fibrotic matrix. HEHE is characterized as a low-to-moderate grade malignant tumor and is classified into three types: solitary, multiple, and diffuse. Both the etiology and characteristic clinical manifestations of HEHE are unclear. However, HEHE has a characteristic appearance on imaging including ultrasound, magnetic resonance imaging, and positron emission tomography/computerized tomography. Still, its diagnosis depends mainly on pathological findings, with immunohistochemical detection of endothelial markers cluster of differentiation 31 (CD31), CD34, CD10, vimentin, and factor VIII antigen as the basis of diagnosis. Hepatectomy and/or liver transplantation are the first choice for treatment, but various chemotherapeutic drugs are reportedly effective, providing a promising treatment option. In this review, we summarize the literature related to the diagnosis and treatment of HEHE, which provides future perspectives for the clinical management of HEHE.
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Affiliation(s)
- Kai Kou
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yu-Guo Chen
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Jian-Peng Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xiao-Dong Sun
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Da-Wei Sun
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Shu-Xuan Li
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Guo-Yue Lv
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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