Optimal outcomes for liver-dominant metastatic breast cancer with transarterial chemoembolization with drug-eluting beads loaded with doxorubicin.

The purpose of this study was to evaluate the efficacy of image-guided delivery of locoregional chemotherapy to breast cancer hepatic metastases using doxorubicin-loaded drug-eluting beads (DEBDOX). An IRB-approved multi-center, prospective, open, non-controlled repeat treatment registry to investigate the safety and efficacy of doxorubicin microspheres in the treatment of patients with unresectable liver metastasis from breast cancer was reviewed. Statistical analysis was performed with differences of P < 0.05 considered significant. About 40 patients with metastatic breast cancer (MBC) to the liver underwent a total of 75 image-guided procedures with hepatic arterial drug-eluting beads loaded with doxorubicin (DEBDOX). Treatment was well tolerated with a total of eight patients sustaining 13 adverse events within the 30 days of each treatment session. All adverse events were either a grade I or grade II in toxicity. After a median follow-up of 12 months in all patients, the hepatic progression-free survival was a median of 26 months and overall survival was a median of 47 months. The treatment of hepatic metastasis from MBC using DEBDOX is an effective local therapy with very high response rates and a very safe toxicity profile. In comparison to chemotherapy alone, consideration of hepatic-directed therapy is warranted in patients with liver-dominant metastatic disease.

Imaged guided transarterial chemoembolization with drug-eluting beads loaded with doxorubicin (DEBDOX) for hepatic metastases from melanoma: early outcomes from a multi-institutional registry.

Patients with unresectable hepatic metastases from melanoma present a difficult clinical challenge due to lack of locoregional control and poor response to systemic chemotherapy. This study aims to examine the early outcomes of the novel treatment of unresectable hepatic metastases from melanoma with drug-eluting beads loaded with doxorubicin (DEBDOX) delivered via image guided transarterial chemoembolization. A multicenter prospective open registry of hepatic-directed therapy with drug-eluting beads was reviewed. Six patients underwent 12 DEBDOX treatments for liver-predominant, unresectable metastases from melanoma. Six adverse events (grade 1 or 2) were exhibited in three patients and were most commonly emesis, nausea, and pain. Over a median follow-up of 12 months (range: 6-17), response rates of 100 per cent, 83 per cent, and 60 per cent were observed at 3, 6, and 9 months respectively, based on standardized computed tomographic criteria. A median survival of 12.3 months after initial DEBDOX treatment was observed. Initial results for liver-directed therapy of hepatic-dominant metastatic disease from melanoma with DEBDOX demonstrate that this is a safe and well-tolerated treatment option with favorable response rates and survival characteristics at this point in follow-up. Salvage therapy with DEBDOX should be considered in the multidisciplinary therapy for this clinical dilemma.

Congenital aorto-azygous fistula treated with coil embolization: case report and review of the literature.

Arteriovenous fistulas between the aorta and the azygous vein usually manifest as a continuous audible murmur mimicking a patent ductus arteriosus when observed at birth. Symptoms when present during childhood are related to dyspnea or cardiac insufficiency. Embolotherapy of congenital vascular malformations is possible. However when this less invasive treatment fails, surgical treatment is sometimes necessary. We describe the case of a 12-year-old child with a large thoracic arteriovenous fistula between the descending thoracic aorta and the azygous vein, which was closed successfully by coil embolization. Available data in the literature suggest that coil embolization of aorto-azygous fistulas is usually successful.