Exploring Treatments for Hepatic Epithelioid Hemangioendothelioma: A Subsegmental Bland Embolization Case Series With Review

Introduction Epithelioid Hemangioendothelioma is a rare vascular neoplasm unresponsive to chemotherapy, radiotherapy, or immunotherapy. Surgical options are considered; however, recurrence rates reach up to 30%. Irreversible electroporation is difficult with large or numerous lesions. This paper reviews treatment options, exploring long-term response after subsegmental bland embolization of hepatic epithelioid hemangioendothelioma (HEHE). Case Series This IRB approved retrospective study involved 3 patients after subsegmental bland embolization of 8 total HEHE lesions. Preoperative and postoperative contrast enhanced CT scans were compared up to 4 years post-operatively. Patient 1, a 28-year-old male whose single lesion involved segments 4, 5, and 8, with a mean volume of 458.1 mL that progressed despite treatment with Axitinib and Pembrolizumab. One-month postembolization volume was 439.6 mL and 4-year follow-up volume was 128.9 mL, representing a 72% volume reduction. The second patient, a 54-year-old female could not finish her IRE treatments. Four of the lesions, 2 right-sided and 2 left-sided, were treated with subsegmental bland embolization (mean volume 108.8 mL, SD 86.1 mL). The 1-month postembolization mean volume was 78.1 mL (SD 48.3 mL), and 4-years mean volume was 9.8 mL (SD 8.4 mL), representing a 91% tumor reduction volume. The third patient, a 61-year-old female presented with numerous, bilobar lesions not amenable to IRE. Three lesions were treated with subsegmental bland embolization (mean volume 52.4 mL, SD 55.9 mL). One-month postembolization, the mean volume was 49.9 (SD 49.5 mL). One-and-a-half-year follow-up demonstrated a mean volume of 38.8 mL (SD 48.9 mL), representing a 22% reduction in mean tumor volume. No grade 3 or greater complications after any procedure occurred. Conclusions Subsegmental bland embolization is safe and effective, having the potential to stabilize HEHE not otherwise suitable for surgery or IRE. All patients achieved sustained disease control with most lesions demonstrating a partial response. Possible future directions include starting a prospective patient registry to obtain additional long-term data regarding subsegmental bland embolization outcomes.