Transcatheter arterial chemoembolization with spherical embolic material for locally advanced breast cancer: first report of HepaSphere™ treatment for primary breast cancer

Transarterial chemoembolization as a part of multi-modality treatment with drug-eluting beads for locally advanced breast cancer: A case report

Locally advanced breast cancer (LABC) is generally treated with combined-modality therapy including systemic chemotherapy, surgery, radiotherapy, and targeted therapy due to its nature of rapid onset of metastatic disease and poor prognosis. In this case report, we present a 61-year-old female who suffered from a huge protruding breast mass (16.2cm) with superficial ulcerative wound noted for three months. LABC was diagnosed via core needle biopsy and PET-CT examination. Initially, she received combined systemic chemotherapy, hormone therapy and radiation therapy; however, severe necrosis caused rupture in part of the breast mass and extensive wound discharge resulting in difficulty in wound care and prolonged disease course. Trans-arterial chemoembolization with drug-eluting beads (DEB-TACE) was applied as a part of combined-modality therapy for shortening the time before surgery. HepaSphere (as one of the DEB) loaded with high dose of epirubicin (total 80mg) was infused intra-arterially due to the nature of slow-releasing effect and longer duration of ischemic effect. Shortly after DEB-TACE following in about 40 days, surgery was smoothly performed. Post-operative adjuvant target therapy and adjuvant chemotherapy with taxane were administered. There was no evidence of local recurrence or distal metastases after 9 months of follow-up. It is suggested that performing DEB-TACE prior to surgery becomes a part of multimodality treatment of LABC to achieve better local control, better wound care and shortened treatment course.

Long-term Histopathologic Follow-up of a Spherical Embolic Agent; Observation of the Transvascular Migration of HepaSphereTM

Very few studies have been published on the long-term histopathologic follow-up of spherical embolic agents after their injection. To our knowledge, there are no reports in the literature regarding pathological analysis of the transvascular migration of HepaSphere particles. We here report a case of a patient with hepatocellular carcinoma (HCC) who underwent liver transplantation 12 months after drug eluting microsphere transcatheter arterial chemoembolization (DEM-TACE), and long-term histopathologic follow-up of the microspheres was performed. Furthermore, to our knowledge, this is the first report in which transvascular migration of a HepaSphere particle was confirmed histologically. A 60-year-old male with chronic hepatitis B was treated with entecavir and seroconversion was obtained. The patient had decompensated cirrhosis, and desired to undergo living donor liver transplantation (LDLT). However, 2 HCC tumors of 3  cm or less were detected in his liver. The transplantation surgeon proposed DEM-TACE as a bridge therapy. The HCCs were located in the right lobe and lateral segment of the liver. A 1.9  F preshaped microcatheter (ProgreatΣ, Terumo, Japan) was selectively inserted into the A3 and anterior segmental branch, 10  mg of epirubicin was injected into each artery, and the arteries were embolized with 7  mg and 13  mg of HepaSphere loaded with epirubicin, respectively. Two months later, contrast-enhanced CT displayed a complete response. At that time, lung metastasis was suspected, but after partial lung resection, the patient was diagnosed as having inflammatory granuloma. One year after DEM-TACE treatment, LDLT was performed. No cancerous cells were detected in the area where the tumor was present, but 22 HepaSphere particles were detected. All particles were present in the interstitium. Furthermore, the transvascular migration of a HepaSphere particle was histologically confirmed. The largest and smallest HepaSphere diameters were 241.6  ±  52.5  µm and 186.5  ±  41.4  µm, respectively, and deformity was 22.6% ± 13.0 %. All the HepaSpheres detected in the examined pathological specimen were noted to be extravascular.