Microwave ablation and transcatheter arterial chemoembolization for hepatic epithelioid hemangioendothelioma two case reports with literature review.

backgroundHepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular sarcoma in which surgical resection or liver transplantation is often not feasible due to multifocal or unresectable disease. Although various non-surgical treatments, including chemotherapy, targeted therapy and immunotherapy have been employed, their effectiveness remains inconsistent. Consequently, there is limited data on durable, minimally invasive treatment strategies. This report presents the long-term outcomes of two distinct, minimally invasive treatment strategies, staged microwave ablation (MWA) alone and transcatheter arterial chemoembolization (TACE) followed by MWA, highlighting their potential for durable disease control. CASE DESCRIPTION: We describe two patients with pathologically confirmed, unresectable HEHE who achieved sustained complete response (CR). Case 1 was a 47-year-old woman with multifocal HEHE that progressed despite prior systemic therapy. She underwent staged MWA and maintained CR for 40 months according to mRECIST criteria. Case 2 was a 53-year-old man with multiple large, confluent hepatic lesions (largest diameter 6.9 cm) treated with combined TACE and MWA, achieving CR maintained for 84 months, with substantial tumor regression and no recurrence.

conclusionsIn two patients with unresectable HEHE, staged MWA alone or TACE followed by MWA was associated with durable radiologic complete responses. These observations warrant validation in larger multicenter cohorts with standardized response and safety reporting.