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Le Tat T, Jost R, Kuoch V, Carlier RY, El Hajjam M, Zhou J. Arterial embolization for massive bleeding from a locally advanced breast tumor. Radiol Case Rep 2024; 19:4698-4701. [PMID: 39234004 PMCID: PMC11372593 DOI: 10.1016/j.radcr.2024.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 09/06/2024] Open
Abstract
Advances in breast cancer treatment have markedly reduced the incidence of massive bleeding, yet severe hemorrhage remains a critical issue in locally advanced or metastatic cases. Traditional management strategies often prove inadequate for significant bleeding, highlighting the need for alternative interventions. We detail the management of a 64-year-old patient with a neglected locally advanced breast tumor, leading to life-threatening hemorrhage. Conventional bleeding control measures failed, necessitating microsphere embolization. Effective hemostasis was achieved without adverse events or recurrence of bleeding, allowing for the initiation of chemotherapy. This case underscores the rarity yet potential severity of hemorrhage in breast cancer, challenging conventional management. Embolization, typically reserved for other hemorrhagic conditions, is appearing as a viable alternative for breast cancer-related hemorrhage, particularly in large tumors where surgery is impractical. Further research is necessary to establish its role in managing minor bleeding.
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Affiliation(s)
- Thomas Le Tat
- Department of Interventional Radiology, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, Corbeil-Essonnes 91100, France
- Department of Radiology, Hôpital National d'Instruction des Armées Percy, 2 Rue Lieutenant Raoul Batany, Clamart 92140, France
- Department of Radiology, Hôpital Ambroise Paré (AP-HP), 9 Av. Charles de Gaulle, Boulogne-Billancourt 92100, France
| | - Raphaël Jost
- Department of Interventional Radiology, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, Corbeil-Essonnes 91100, France
| | - Viseth Kuoch
- Department of Interventional Radiology, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, Corbeil-Essonnes 91100, France
| | - Robert-Yves Carlier
- Department of Radiology, Hôpital Ambroise Paré (AP-HP), 9 Av. Charles de Gaulle, Boulogne-Billancourt 92100, France
| | - Mostafa El Hajjam
- Department of Radiology, Hôpital Ambroise Paré (AP-HP), 9 Av. Charles de Gaulle, Boulogne-Billancourt 92100, France
| | - Jeffery Zhou
- Department of Radiology, Hôpital Ambroise Paré (AP-HP), 9 Av. Charles de Gaulle, Boulogne-Billancourt 92100, France
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Zhang J, Zhang J, Niu X, Zhou Y, Guo Y, Wang Y, Shou F. Discussing the safety and effectiveness of transcatheter arterial embolization combined with intravenous chemotherapy in treating locally advanced breast cancer. Sci Rep 2024; 14:6003. [PMID: 38472493 PMCID: PMC10933325 DOI: 10.1038/s41598-024-56642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/08/2024] [Indexed: 03/14/2024] Open
Abstract
To investigate the efficacy and safety of drug-eluting bead-transarterial chemoembolization (DEB-TACE) combined with systemic chemotherapy in HR+/Her2- locally advanced breast cancer (LABC) patients. A controlled study was conducted on LABC patients treated at Jianyang People's Hospital and the First Affiliated Hospital of Chengdu Medical College from December 2020 to June 2022. The patients were randomly divided into the experimental group and the control group. The experimental group received DEB-TACE combined with the TAC regimen (175 mg/m2 paclitaxel-loaded albumin, 50 mg/m2 Doxorubicin, and 500 mg/m2 cyclophosphamide), while the control group received the TAC regimen intravenously. The therapeutic efficacy was evaluated using the mRECIST criteria. Statistical analysis was performed using SPSS 22.0 software, and baseline characteristics, overall response rate (ORR), pathological complete response (PCR), adverse reactions, and complications were compared between the two groups using paired t-test and chi-square test. A total of 60 patients were included, with 30 patients in the experimental group (50%) and 30 patients in the control group (50%). After the first treatment, the ORR was 90% in the experimental group and 60% in the control group (P < 0.05). The overall ORR was 100% in the experimental group and 83% in the control group (P < 0.05). PCR was achieved in 14 patients (47%) in the experimental group and 4 patients (13%) in the control group. The main adverse reactions in the experimental group were skin blistering, pigmentation, and pain. There was no statistically significant difference in vomiting and grade II or above bone marrow suppression between the two groups. No grade III or above adverse events occurred in either group. The comparison of tumor shrinkage between the two groups was P = 0.051, and axillary lymph node shrinkage was P < 0.05. The use of drug-eluting beads in combination with neoadjuvant chemotherapy is a feasible and safe treatment option for locally advanced breast cancer patients.
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Affiliation(s)
- Jingjun Zhang
- Jianyang People's Hospital, Jianyang City, 641400, Sichuan Province, China
| | - Jie Zhang
- The First Affiliated Hospital of Chengdu Medical College, Chengdu City, Sichuan Province, China
| | - Xiangke Niu
- Affiliated Hospital of Chengdu University, Chengdu City, Sichuan Province, China
| | - Yongxiang Zhou
- Jianyang People's Hospital, Jianyang City, 641400, Sichuan Province, China
| | - Yufeng Guo
- Jianyang People's Hospital, Jianyang City, 641400, Sichuan Province, China
| | - Yuanzhi Wang
- Jianyang People's Hospital, Jianyang City, 641400, Sichuan Province, China
| | - Feng Shou
- Jianyang People's Hospital, Jianyang City, 641400, Sichuan Province, China.
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Wei X, Zhang HC, Tu YH, Li X, Wu WS. Interventional chemoembolization for the treatment of severe ulcerative bleeding caused by advanced breast cancer: A report of two cases. Exp Ther Med 2024; 27:36. [PMID: 38125357 PMCID: PMC10731400 DOI: 10.3892/etm.2023.12324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/01/2023] [Indexed: 12/23/2023] Open
Abstract
Local ulcerative cutaneous hemorrhage resulting from breast cancer profoundly effects the quality of life of patients, at times even posing a threat to life. While early diagnosis rates of breast cancer have shown improvement, some patients may present at an advanced stage upon consultation. Presently, there is no standardized treatment approach for these patients. In this context, the present study presented two case studies detailing the use of interventional embolization chemotherapy for addressing severe local ulcerative hemorrhage associated with breast cancer. Post-treatment, there was a notable amelioration in the mammary ulceration among the patients, an elevated hemoglobin level compared with baseline and a consequent enhancement in their overall quality of life. These cases may serve as valuable references for the management of such clinical situations.
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Affiliation(s)
- Xing Wei
- Emergency Department, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510130, P.R. China
| | - Hong-Chao Zhang
- Department of Acupuncture and Rehabilitation, Guangzhou Yuexiu Orthopedics and Traumatology Rehabilitation Hospital, Guangzhou, Guangdong 510199, P.R. China
| | - Yue-He Tu
- Fifth Department of Oncology, Jinshazhou Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510168, P.R. China
| | - Xiang Li
- Fifth Department of Oncology, Jinshazhou Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510168, P.R. China
| | - Wei-Sheng Wu
- Medical Clinic, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510130, P.R. China
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Minici R, Guzzardi G, Venturini M, Fontana F, Coppola A, Spinetta M, Piacentino F, Pingitore A, Serra R, Costa D, Ielapi N, Guerriero P, Apollonio B, Santoro R, Mgjr Research Team, Brunese L, Laganà D. Transcatheter Arterial Embolization (TAE) of Cancer-Related Bleeding. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1323. [PMID: 37512135 PMCID: PMC10383256 DOI: 10.3390/medicina59071323] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/17/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Roughly 10% of cancer patients experience an episode of bleeding. The bleeding severity can range from occasional trivial bleeds to major bleeding. The treatment for the bleeding may vary, depending on the clinical condition and anatomical site, and may include various strategies, among which TAE is a cornerstone of major bleeding management. However, the existing literature on tumor hemorrhages is inconsistent. The objective of this multicenter retrospective cohort study was to evaluate the effectiveness and safety of arterial embolization in the treatment of tumor hemorrhages in patients with solid cancers. Materials and Methods: The data for patients with solid cancers undergoing TAE for the management of tumor hemorrhages from January 2020 to May 2023 were gathered. Results: A total of 92 patients with cancer-related bleeding were treated between January 2020 and May 2023. No bleeding was detected by X-ray angiography (XA) in 12 (13%) cases; therefore, a blind embolization was performed. The most common bleeding site was the liver (21.7%). A total of 66 tumor hemorrhages were spontaneous. The most commonly used embolic agent was polyvinyl alcohol (PVA) particles (30.4%). Technical success was achieved in 82 (89.1%) cases, with an 84.8% clinical success rate related to 14 cases of rebleeding. Proximal embolization was performed for 19 (20.7%) patients. Complications were recorded for 10 (10.9%) patients. The 30-day bleeding-related mortality was 15.2%. The technical success, clinical success, proximal embolization rate, and 30-day rebleeding were worse in the subset of patients undergoing TAE with coils. Conclusions: Transcatheter arterial embolization (TAE) represents a viable and potentially life-saving therapeutic approach in the management of tumor hemorrhages, demonstrating a notable effectiveness and safety. The TAE of bleeding tumors using coils resulted in a higher rate of non-superselective proximal embolization, with a trend toward lower clinical success rates and higher rebleeding episodes.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
| | - Marco Spinetta
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
| | - Armando Pingitore
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Davide Costa
- Department of Law, Economics and Sociology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00185 Rome, Italy
| | - Pasquale Guerriero
- Radiology Unit, Santobono-Pausilipon Hospital, 80129 Naples, Italy
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
| | | | - Rita Santoro
- Haemophilia and Thrombosis Center, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | | | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
- Scientific Committee of the Italian National Institute of Health (Istituto Superiore di Sanità, ISS), 00161 Rome, Italy
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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