Percutaneous Sclerotherapy with Bleomycin and Ethiodized Oil: Is It a Promising Treatment for Giant Liver Hemangioma?
2022; Radiological Society of North America; Volume: 303; Issue: 3 Linguagem: Inglês
10.1148/radiol.212305
ISSN1527-1315
AutoresRuize Gao, Wen-bing Sun, Jun Gao,
Tópico(s)Viral-associated cancers and disorders
ResumoHomeRadiologyVol. 303, No. 3 PreviousNext CommunicationsFree AccessLetters to the EditorPercutaneous Sclerotherapy with Bleomycin and Ethiodized Oil: Is It a Promising Treatment for Giant Liver Hemangioma?Rui-Ze Gao, Wen-bing Sun, Jun Gao Rui-Ze Gao, Wen-bing Sun, Jun Gao Author AffiliationsDepartment of Hepatobiliary Surgery, Beijing Chao-yang Hospital, Capital Medical University, 5 Jingyuan Road, Beijing 100043, Chinae-mail: [email protected]Rui-Ze GaoWen-bing SunJun Gao Published Online:Mar 22 2022https://doi.org/10.1148/radiol.212305MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Editor:We carefully read with great interest the article by Dr Yazdi and colleagues (1), published in the November 2021 issue of Radiology. We have several questions about the method and would appreciate additional information regarding the study.First, we think that the dose of bleomycin varies depending on the volume of tumor, rather than a fixed dose that was used in hemangiomas with different diameters. Moreover, to achieve complete destruction, the bleomycin must reach all parts of the tumor; however, bleomycin spreads unevenly and the needle needs to be repositioned accordingly, which needs smaller volumes injected each time. We believe it is difficult in the treatment of giant hepatic hemangiomas.Second, it is difficult to understand that no complication of fever was detected, even if the lesion volumes were significantly reduced (76%). Castells et al (2) reported a 33% (25 of 75) incidence of fever after transcatheter arterial embolization (TAE) with bleomycin, which is closely related to the volume of tumor necrosis (P < .02).Third, the mechanism of sclerotherapy in treating hepatic hemangiomas is delivery of drugs into the blood sinuses, causing atrophy and fibrosis of the hemangiomas, which is similar to TAE. However, TAE is not considered as curative because of recurrence caused by vascular recanalization (3). Therefore, we think long-term follow-up is necessary to observe whether there will be recurrence after sclerotherapy.Disclosures of conflicts of interest: R.Z.G. No relevant relationships. W.B.S. No relevant relationships. J.G. No relevant relationships.References1. Ayoobi Yazdi N, Mehrabinejad MM, Dashti H, Pourghorban R, Nassiri Toosi M, Rokni Yazdi H. Percutaneous Sclerotherapy with Bleomycin and Ethiodized Oil: A Promising Treatment in Symptomatic Giant Liver Hemangioma. Radiology 2021;301(2):464–471. Link, Google Scholar2. Castells A, Bruix J, Ayuso C, et al. Transarterial embolization for hepatocellular carcinoma. Antibiotic prophylaxis and clinical meaning of postembolization fever. J Hepatol 1995;22(4):410–415. Crossref, Medline, Google Scholar3. Ji J, Gao J, Zhao L, Tu J, Song J, Sun W. Computed Tomography-Guided Radiofrequency Ablation Following Transcatheter Arterial Embolization in Treatment of Large Hepatic Hemangiomas. Medicine (Baltimore) 2016;95(15):e3402. Crossref, Medline, Google ScholarReferences1. Ayoobi Yazdi N, Mehrabinejad MM, Dashti H, Pourghorban R, Nassiri Toosi M, Rokni Yazdi H. Percutaneous sclerotherapy with bleomycin and ethiodized oil: a promising treatment in symptomatic giant liver hemangioma. Radiology 2021;301(2):464–471. Link, Google Scholar2. Ayoobi Yazdi N, Dashti H, Batavani N, Borhani A, Shakiba M, Rokni Yazdi H. Percutaneous sclerotherapy for giant symptomatic liver hemangiomas: a pilot study. J Vasc Interv Radiol 2018;29(2):233–236. Crossref, Medline, Google Scholar3. Furumaya A, van Rosmalen BV, Takkenberg RB, et al. Transarterial (Chemo-)Embolization and Lipiodolization for Hepatic Haemangioma. Cardiovasc Intervent Radiol 2019;42(6):800–811. Crossref, Medline, Google Scholar4. Zhang W, Chen G, Ren JG, Zhao YF. Bleomycin induces endothelial mesenchymal transition through activation of mTOR pathway: a possible mechanism contributing to the sclerotherapy of venous malformations. Br J Pharmacol 2013;170(6):1210–1220. Crossref, Medline, Google Scholar5. Rokni Yazdi H, Ayoobi Yazdi N, Mehrabinejad MM, et al. Long-term follow-up of giant symptomatic hepatic hemangiomas treated with direct sclerotherapy: introducing a new approach. Arab J Interv Radiol 2020;04(03):S27. Google ScholarReferences1. Ayoobi Yazdi N, Mehrabinejad MM, Dashti H, Pourghorban R, Nassiri Toosi M, Rokni Yazdi H. Percutaneous Sclerotherapy with Bleomycin and Ethiodized Oil: A Promising Treatment in Symptomatic Giant Liver Hemangioma. Radiology 2021;301(2):464–471. Link, Google Scholar2. Castells A, Bruix J, Ayuso C, et al. Transarterial embolization for hepatocellular carcinoma. Antibiotic prophylaxis and clinical meaning of postembolization fever. J Hepatol 1995;22(4):410–415. Crossref, Medline, Google Scholar3. Ji J, Gao J, Zhao L, Tu J, Song J, Sun W. Computed Tomography-Guided Radiofrequency Ablation Following Transcatheter Arterial Embolization in Treatment of Large Hepatic Hemangiomas. Medicine (Baltimore) 2016;95(15):e3402. Crossref, Medline, Google ScholarResponseNiloofar Ayoobi Yazdi*, Mohammad-Mehdi Mehrabinejad*, Ramin Pourghorban†, Mohssen Nassiri Toosi‡, Hadi Rokni Yazdi* Niloofar Ayoobi Yazdi*, Mohammad-Mehdi Mehrabinejad*, Ramin Pourghorban†, Mohssen Nassiri Toosi‡, Hadi Rokni Yazdi* Author AffiliationsDepartment of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of IranDepartment of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of IranLiver Transplantation Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Irane-mail: [email protected]We thank Dr Gao and colleagues for their interest in our study (1). First, we used the fixed dose of 45 IU bleomycin based on our previous pilot study (2). The dose of bleomycin in intra-arterial embolization studies was 15–45 IU of bleomycin with a total ethiodized oil/bleomycin volume of 12–30 mL based on lesion size (3). Therefore, the dose of bleomycin and lipiodol in our study was still within the range used in different intra-arterial studies, but there is no consensus yet on the optimal dose and how to adjust it. Interestingly, even though a fixed dose of bleomycin was used for patients with different lesion volumes, further analyses in our study showed that pretreatment volume had no correlation with the change in volume (r = –0.15; P = .50). In our study, we injected a single site near the center of the hemangioma, avoiding its central hypoechogenicity or echo-free area, if any, and we noted the slow spread of the contrast agent to more peripheral parts. This resulted in a peripheral spread on fluoroscopy in both our pilot and trial studies (1,2). On the other hand, multidirectional and multiple passes could increase the risk of complications.Second, there is a possibility of nontarget embolization, postembolization syndrome, and ischemic changes in trans-arterial technique, which might be a reason for the postprocedural fever. However, the mechanism of percutaneous sclerotherapy with bleomycin is most likely due to the involvement of Slug (transcription factor)-dependent endothelial mesenchymal transition (4).Third, we did not see the recurrence in our patients at follow-ups of up to 36 months in our different studies (1,2,5). The giant liver hemangiomas could be fed by multiple nourishing vessels, making total embolization challenging in a few cases. The repeat embolization, ablation, or open surgery were usually performed after transarterial embolization to reach a better clinical outcome and/or more shrinkage, if necessary, rather than to treat a recurrent hemangioma. However, the rate of surgery or repeat embolization had been low in transarterial embolization, especially when performed with sclerosing agents rather than particles (3). Disclosures of conflicts of interest: N.A.Y. No relevant relationships. M.M.M. No relevant relationships. R.P. No relevant relationships. M.N.T. No relevant relationships. H.R.Y. No relevant relationships.References1. Ayoobi Yazdi N, Mehrabinejad MM, Dashti H, Pourghorban R, Nassiri Toosi M, Rokni Yazdi H. Percutaneous sclerotherapy with bleomycin and ethiodized oil: a promising treatment in symptomatic giant liver hemangioma. Radiology 2021;301(2):464–471. Link, Google Scholar2. Ayoobi Yazdi N, Dashti H, Batavani N, Borhani A, Shakiba M, Rokni Yazdi H. Percutaneous sclerotherapy for giant symptomatic liver hemangiomas: a pilot study. J Vasc Interv Radiol 2018;29(2):233–236. Crossref, Medline, Google Scholar3. Furumaya A, van Rosmalen BV, Takkenberg RB, et al. Transarterial (Chemo-)Embolization and Lipiodolization for Hepatic Haemangioma. Cardiovasc Intervent Radiol 2019;42(6):800–811. Crossref, Medline, Google Scholar4. Zhang W, Chen G, Ren JG, Zhao YF. Bleomycin induces endothelial mesenchymal transition through activation of mTOR pathway: a possible mechanism contributing to the sclerotherapy of venous malformations. Br J Pharmacol 2013;170(6):1210–1220. Crossref, Medline, Google Scholar5. Rokni Yazdi H, Ayoobi Yazdi N, Mehrabinejad MM, et al. Long-term follow-up of giant symptomatic hepatic hemangiomas treated with direct sclerotherapy: introducing a new approach. Arab J Interv Radiol 2020;04(03):S27. Google ScholarArticle HistoryPublished online: Mar 22 2022Published in print: June 2022 FiguresReferencesRelatedDetailsRecommended Articles Percutaneous Sclerotherapy with Bleomycin and Ethiodized Oil: A Promising Treatment in Symptomatic Giant Liver HemangiomaRadiology2021Volume: 301Issue: 2pp. 464-471Percutaneous Sclerotherapy with Bleomycin and Ethiodized Oil: A Welcomed Minimally Invasive Treatment for Giant Liver HemangiomasRadiology2021Volume: 301Issue: 2pp. 472-473Pilot Evaluation of Angiogenesis Signaling Factor Response after Transcatheter Arterial Embolization for Hepatocellular CarcinomaRadiology2017Volume: 285Issue: 1pp. 311-318Local-Regional Treatment of Hepatocellular Carcinoma: A Primer for RadiologistsRadioGraphics2022Volume: 42Issue: 6pp. 1670-1689Portal Venous Interventions: State of the ArtRadiology2016Volume: 278Issue: 2pp. 333-353See More RSNA Education Exhibits Updates on Combination TACE and Ablation Therapy for HCC: A Case-Based Review of Technique, Results and ComplicationsDigital Posters2022To Be Viable Hcc Or Not To Be? ThatâS The QuestionDigital Posters2021Thoracic Complications in Liver Directed Therapy and Hepatic InterventionDigital Posters2019 RSNA Case Collection LI-RADS 5RSNA Case Collection2022Pulmonary arteriovenous malformationRSNA Case Collection2020Hepatic AngiosarcomaRSNA Case Collection2021 Vol. 303, No. 3 Metrics Altmetric Score PDF download
Referência(s)