IRQ Articles

Solved on SIR Connect 

07-19-2018 19:15

Giant hepatic hemangioma management

By Donna D’Souza, MD, Mithil B. Pandhi, DO, and Sudhen B. Desai, MD  Summer 2018

This column summarizes patient cases posted to SIR Connect (SIR’s popular online member community), the responses from other SIR members and how that feedback helped the original poster. To see how SIR’s online community can help you, visit SIR Connect at connect.sirweb.org.

Original post

I am curious what others in this group have used to treat symptomatic giant liver hemangiomas—particularly what has worked and what hasn’t worked.

—Donna D’Souza, MD

Read the full discussion thread at bit.ly/2JAxsvJ.

Background

A large part of my practice is interventional oncology. Symptomatic giant liver hemangiomas are uncommon and are usually surgically resected, so embolization of giant hemangiomas is something we rarely do. In the past we have used bland particle embolization with mixed results.

Why SIR Connect?

There are different approaches to the IR management of giant liver hemangiomas, including bland embolization, chemoembolization and thermal ablation. Since our previous results with bland embolization were variable, I was curious about others’ experience with treating these uncommon lesions, and SIR Connect was the quickest and most efficient way to reach out to the IR community to get some answers.

In the absence of SIR Connect, I would have spent some time phoning and emailing other IRs I know to see who had experience treating large liver hemangiomas. I had already done a literature review, but it is very helpful to have support from colleagues who can describe their real clinical experience and answer any questions I may have.

What posts were most valuable to you?

I was interested in chemoembolization with bleomycin because there are some case series supporting this approach. A couple of IRs on SIR Connect described their technique and results with bleomycin and attached impressive pre- and posttreatment images. Seeing real results from IRs in our local SIR community that supported the case series I had read solidified my interest in using bleomycin. I was also able to contact these IRs directly and ask a few more questions to clarify my approach.

How did the solicited input impact the outcome of the case?

I only recently treated this patient with bleomycin chemoembolization so I do not have any information on the outcome yet. However, the solicited input clarified the dose, drug-lipiodol ratio and other technical factors that made the procedural planning and execution much easier.

I have not treated any more patients with a giant hemangioma yet but plan on using the same bleomycin chemoembolization technique for future patients so I can gauge the response in a cohort of patients.

Additional commentary

The management of giant hepatic hemangiomas is an often-raised topic on SIR Connect. Suggested reading on treatment options including bland embolization, sclerotherapy, radiofrequency ablation (Sharpe and Dodd, JVIR 2012), microwave ablation (Zimlewicz et al., CVIR 2014), bleomycin with lipiodol (Zeng et al., 2004; Bozkaya et al. 2014) and a combination of embolization with subsequent ablation.

Sharpe and Dodd:
bit.ly/2JDszSP

Zeng:
ncbi.nlm.nih.gov/pubmed/15383851

Bozkaya:
ncbi.nlm.nih.gov/pubmed/23580121

Zimlewciz:
link.springer.com/article/10.1007%2Fs00270-014-0934-x

SIR Connect posts:
bit.ly/2M4LELY
bit.ly/2xSsea3

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