TRANSARTERIAL CHEMOEMBOLIZATION FOR SYMPTOMATIC PALLIATION OF ADVANCED BREAST CANCER: A PILOT STUDY FOR EFFICACY AND SAFETY

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Abstract

Background

Advanced breast cancers may be associated with serious clinical symptoms corrupting proper quality of life. Traditional treatment including medication and radiotherapy have been preferentially applied to control them, but might be insufficient or useless. This study was aimed to evaluate the efficacy and safety of transarterial chemoembolization in the symptomatic palliation of advanced breast cancer patients.

Methods

Total 20 patients were enrolled (From 2008 June to 2011 December). All patients complained of intractable clinical manifestations corrupting proper quality of life—severe pain (n = 16 in breast, mastectomy site, bones), uncontrolled bloody and/or non-bloody discharge from skin or soft tissue of the breast or mastectomy site (n = 7), intractable pleural effusion (n = 4), limit of motion (n = 2), general discomfort (n = 7). Thirteen patients had two or more than two intractable symptoms. Correlating clinical symptoms with findings on CT or PET-CT, arterial suppliers to problematic lesions were selected. Cocktail of chemoagents (gemcitabine 200 mg, oxaliplatine 50 mg, adriamycin 10 mg mixed in glycirrhyzinic acid 40 ml) was infused, followed by embolization with micro-particles (40–50 µm) when it was needed. This treatment was repeated per 4–8 weeks according to the patients' response and clinical condition.

Results

A significant reduction of pain grading score was demonstrated in 11 patients (more than 4 in pain grading score, reduction of analgesics dose). Discharge was significantly controlled in five patients. Pleural effusion was reduced in four patients (reduction of daily drainage >50%). The limit of motion was improved in one patient. General discomfort was improved in four patients. The time to maximum clinical improvement ranged from 2 to 8 days. The duration maintaining clinical improvement ranged from 2 to 6 weeks.

Conclusions

In advanced breast cancer patients with intractable clinical manifestations, transarterial chemoembolization is helpful for restoring proper quality of life. However, the improvement maintaining duration is limited with individual variation, which makes the repetition of the procedure needed for clinical maintenance.

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