Dexamethasone Prophylaxis to Alleviate Postembolization Syndrome after Transarterial Chemoembolization for Hepatocellular Carcinoma: A Randomized, Double-Blinded, Placebo-Controlled Study

2017 ◽  
Vol 28 (11) ◽  
pp. 1503-1511.e2 ◽  
Author(s):  
Hyun Yang ◽  
Jein Seon ◽  
Pil Soo Sung ◽  
Jung Suk Oh ◽  
Hae Lim Lee ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Transarterial Chemoembolization ◽  
Controlled Study ◽  
Double Blinded ◽  
Postembolization Syndrome

scholarly journals The Effect of Transarterial Chemoembolization in Combination With Kang’ai Injection on Patients With Intermediate Stage Hepatocellular Carcinoma: A Prospective Study

2017 ◽  
Vol 17 (2) ◽  
pp. 477-485 ◽  
Author(s):  
Yue-Meng Wan ◽  
Yu-Hua Li ◽  
Zhi-Yuan Xu ◽  
Hua-Mei Wu ◽  
Ying Xu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Size ◽  
Transarterial Chemoembolization ◽  
Intermediate Stage ◽  
Primary Endpoints ◽  
Tumor Number ◽  
Tace Group ◽  
Extrahepatic Metastases ◽  
A Prospective Study ◽  
Postembolization Syndrome

Background: The outcome of patients with intermediate stage hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE) remains poor. Search for a more effective therapy is still necessary. Objective: This study aimed to investigate the effect of combining TACE with Kang’ai (KA) injection for treating patients with intermediate stage HCC. Methods: A total of 89 patients with intermediate stage HCC were enrolled and divided into TACE +KA group (n = 48) receiving repeated TACE plus KA injection, and TACE group (n = 41) receiving repeated TACE alone. All patients were prospectively studied. Primary endpoints were overall survival (OS) and time to radiologic progression (TTP). Results: The TACE + KA group had significantly longer median OS (27.0 vs 21.0 months, P = .038) and TTP (12.0 vs 10.0 months, P = .028) than TACE group. The 1-, 2-, and 3-year OS rates in the TACE + KA group were markedly higher than in TACE group (88.5%, 58.8%, and 20.8% vs 81.3%, 44.9%, and 6.7%, respectively, P = .038), while the 1- and 2-year TTP rates in the TACE + KA group were significantly lower than in TACE group (49.3% and 86.9% vs 75.3% and 100%, P = .028). TACE + KA group displayed significantly lower incidences of intrahepatic and extrahepatic metastases, as well as postembolization syndrome than TACE group ( P < .05). Multivariate analyses revealed group ( P = .023), maximum tumor size ( P = .019), and tumor number ( P = .034) as significant predictors for OS, and group ( P = .046), maximum tumor size ( P = .002) and α-fetoprotein level ( P = .020) as significant predictors for TTP. Both TACE and KA injection were well tolerated. Conclusion: TACE plus KA injection is more effective than TACE alone for treating patients with intermediate stage HCC in this nonrandomized study. Further research is warranted.

Hepatic arterial damage after transarterial chemoembolization for the treatment of hepatocellular carcinoma: comparison of drug-eluting bead and conventional chemoembolization in a retrospective controlled study

2016 ◽  
Vol 58 (2) ◽  
pp. 131-139 ◽  
Author(s):  
Seungsoo Lee ◽  
Kyoung Min Kim ◽  
Shin Jae Lee ◽  
Kwang-Hun Lee ◽  
Do Yun Lee ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Transarterial Chemoembolization ◽  
Controlled Study ◽  
Repeated Treatment ◽  
Selective Embolization ◽  
Tace Group ◽  
Conventional Tace ◽  
Drug Eluting ◽  
Grade Ii ◽  
Arterial Damage

Background Transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) frequently causes feeding artery stenosis or occlusion that may interfere with repeated treatment. Purpose To investigate the incidence and predictors of hepatic arterial damage (HAD) after drug-eluting bead-TACE (DEB-TACE) in comparison with conventional TACE (Conv-TACE). Material and Methods We retrospectively analyzed 54 patients who underwent DEB-TACE for HCC as an initial treatment with follow-up angiography and 54 patients who underwent Conv-TACE using doxorubicin-lipiodol mixture and gelfoam particles for comparison. HAD was evaluated after a single session of TACE and graded as follows: grade I, no significant wall irregularity; grade II, overt stenosis; grade III, occlusion. Results The incidence of HAD was significantly higher in the DEB-TACE group than the Conv-TACE group when analyzed per branch (odds ratio [OR], 6.36; P < 0.001) and per patient (OR, 3.15; P = 0.005). For each HAD grade, the mean doxorubicin dose was greater in the DEB-TACE group than in the Conv-TACE group ( P < 0.001, P = 0.053, and P = 0.01 for grades I, II, and III, respectively). In multivariate analysis, risk factors of HAD included mean doxorubicin dose and selective embolization in the Conv-TACE group ( P = 0.03 and P < 0.001, respectively) and mean doxorubicin dose in the DEB-TACE group ( P = 0.004). Conclusion The incidence and grade of HAD were higher after DEB-TACE compared to Conv-TACE with doxorubicin dose as a possible risk factor. HAD was independent of overall survival in both groups.

scholarly journals Lenvatinib in combination with transarterial chemoembolization for treatment of unresectable hepatocellular carcinoma (uHCC): a retrospective controlled study

2021 ◽  
Author(s):  
Zhigang Fu ◽  
Xiaowei Li ◽  
Jiaming Zhong ◽  
Xiaoxia Chen ◽  
Kunkun Cao ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Adverse Events ◽  
Clinical Outcomes ◽  
Combination Treatment ◽  
Transarterial Chemoembolization ◽  
Tumor Response ◽  
Objective Response ◽  
Controlled Study ◽  
Large Sample Size ◽  
Unresectable Hepatocellular Carcinoma

Abstract Purpose To compare the efficacy and safety of combined treatment with lenvatinib and transarterial chemoembolization (TACE) versus TACE only in patients with unresectable hepatocellular carcinoma (uHCC). Methods Of the 120 patients enrolled in this study, 60 patients received treatment with TACE only, and 60 patients received TACE plus lenvatinib. We retrospectively compared the clinical outcomes including overall survival (OS), progression-free survival (PFS), and tumor response between the two groups. Both PFS and tumor response were based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Adverse events were analyzed to assess the safety profiles. Results The 1-year and 2-year OS rates were significantly higher in the TACE + lenvatinib group (88.4% and 79.8%) than that in the TACE group (79.2% and 49.2%, p = 0.047). A similar PFS benefit was observed in the TACE + lenvatinib group (1-y PFS rate: 78.4% vs. 64.7%, 2-y PFS rate: 45.5% vs. 38.0%, p < 0.001). The best overall objective response rate (ORR) was also better with TACE + lenvatinib treatment (ORR: 68.3% vs. 31.7%, p < 0.001) and disease control rate (DCR) numerically increased in the TACE + lenvatinib treatment (93.3% vs. 86.7%, p = 0.224). Patients’ liver function remained comparable to baseline in the TACE + lenvatinib group. The most common adverse events were decreased albumin (55.0%), hypertension (48.3%) and decreased platelet count (46.7%) in the TACE + lenvatinib group. Conclusions Combination treatment with TACE and lenvatinib may significantly improve clinical outcomes over TACE monotherapy with a manageable safety profile for unresectable HCC. The efficacy of the combination treatment should be validated in prospective studies with a large sample size. Graphical abstract

scholarly journals Risk Factors for the Development of Postembolization Syndrome after Transarterial Chemoembolization for Hepatocellular Carcinoma Treatment

2018 ◽  
Vol 31 (1) ◽  
pp. 22 ◽  
Author(s):  
Mariana Lima ◽  
Sofia Dutra ◽  
Filipe Veloso Gomes ◽  
Tiago Bilhim ◽  
Élia Coimbra
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Transarterial Chemoembolization ◽  
Descriptive Analysis ◽  
Female Gender ◽  
Control Group ◽  
Multivariate Logistic Regression ◽  
Significant Relation ◽  
Potential Risk Factors ◽  
Postembolization Syndrome

Introduction: Hepatic transarterial chemoembolization is a widely used technique for the treatment of hepatocellular carcinoma. The most common complication of this procedure is postembolization syndrome. The main objective of this study was to assess risk factors for the development of postembolization syndrome.Material and Methods: Single-centre retrospective analysis of 563 hepatic transarterial chemoembolization procedures from January 1st, 2014 – December 31st, 2015. Hepatic transarterial chemoembolization was performed with ½ - 2 vials of 100 - 300 μm microspheres loaded with doxorubicin. Patients who experienced postembolization syndrome were identified based on prolongation of hospitalization due to pain, fever, nausea and/or vomiting. A control group with the patients who did not have postembolization syndrome was randomly created (three controls for one case). Descriptive analysis and multivariate logistic regression were performed.Results: The overall prevalence of postembolization syndrome was 6.2%. Hepatic transarterial chemoembolization with doxorubicin dosage above 75 mg (more than one vial), the size of the largest nodule and female gender had statistically significant relation with development of postembolization syndrome (p = 0.030, p = 0.046 and p = 0.037, respectively). Discussion: Doxorrubicin dosage above 75 mg is associated with a higher risk of postembolization syndrome. This result can be helpful for decision-making in clinical practice, whenever it is possible to avoid a higher dose without compromising the efficacy of the treatment. The size of the largest nodule and female gender also constitute risk factors for postembolization syndrome. The other variables studied were not related to the development of postembolization syndrome.Conclusion: The dose of doxorrubicin, the size of the largest nodule treated and female gender are potential risk factors for the development of postembolization syndrome after hepatic transarterial chemoembolization for hepatocellular carcinoma.

scholarly journals Effectiveness of drug-eluting bead transarterial chemoembolization versus conventional transarterial chemoembolization for small hepatocellular carcinoma in Child-Pugh class A patients

2019 ◽  
Vol 11 ◽  
pp. 175883591986607 ◽  
Author(s):  
In Joon Lee ◽  
Jeong-Hoon Lee ◽  
Yun Bin Lee ◽  
Yoon Jun Kim ◽  
Jung-Hwan Yoon ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Transarterial Chemoembolization ◽  
Progression Free Survival ◽  
Target Lesion ◽  
Small Hepatocellular Carcinoma ◽  
Class A ◽  
Tace Group ◽  
Drug Eluting ◽  
Pugh Class ◽  
Postembolization Syndrome

Background: This study aimed to compare the therapeutic effectiveness including progression-free survival (PFS), overall survival (OS), and safety of conventional transarterial chemoembolization (cTACE) and drug-eluting bead transarterial chemoembolization (DEB-TACE) in a superselective fashion for the patients with nodular hepatocellular carcinoma (HCC) ( n ⩽ 5) and Child–Pugh class A. Methods: A total of 198 consecutive patients with nodular HCCs ( n ⩽ 5) and Child–Pugh class A liver function who were initially treated with cTACE ( n = 125) or DEB-TACE ( n = 57) were included retrospectively. The primary endpoint was PFS. Secondary endpoints included time-to-target lesion progression (TTTLP), OS, and safety. Results: The median follow up was 62 months (range, 1–87 months). The PFS was significantly longer in the cTACE group than in the DEB-TACE group (median, 18 months versus 7 months; hazard ratio [HR] = 0.658, log-rank p = 0.031), whereas OS was comparable (log-rank p = 0.299). TTTLP was significantly longer in the cTACE group than in the DEB-TACE group (median, 34 months versus 11 months; log-rank p < 0.001). In the stratification analysis based on tumor size, the cTACE group showed significantly longer TTTLP than the DEB-TACE group in the 1.0–2.0 cm and 2.1–3.0 cm subgroups (HR = 0.188, log-rank p < 0.001 and HR = 0.410, p = 0.015, respectively) but not in the 3.1–5.0 cm and 5.1–10.0 cm subgroups (all p > 0.05). Postembolization syndrome occurred more frequently in the cTACE group than in the DEB-TACE group ( p = 0.006). Conclusions: DEB-TACE is followed by significantly shorter PFS than cTACE in patients with nodular HCCs ( n ⩽ 5) and Child–Pugh class A, although OS is comparable. Postembolization syndrome occurs more frequently in cTACE than in DEB-TACE.

scholarly journals Transarterial chemoembolization combined with iodine-125 seed implantation for patients with hepatocellular carcinoma: a retrospective controlled study

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052094430
Author(s):  
Lei Chen ◽  
Tao Sun ◽  
Xuefeng Kan ◽  
Shi Chen ◽  
Yanqiao Ren ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Transarterial Chemoembolization ◽  
Proportional Hazards Model ◽  
White Cell Count ◽  
Objective Response ◽  
Cox Proportional Hazards Model ◽  
Controlled Study ◽  
Seed Implantation ◽  
Significant Difference ◽  
Iodine 125

Objective To determine if iodine-125 seed implantation improved the efficacy of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) (≤5 cm). Methods We retrospectively reviewed the medical records of 83 consecutive patients with HCC (≤5 cm) who underwent TACE or TACE–iodine-125 from January 2014 to July 2017. The primary endpoint was progression-free survival (PFS). The secondary endpoints were overall survival (OS) and objective response rate (ORR) at 3 months after the first TACE treatment. PFS and OS were calculated using the Kaplan–Meier method and compared using log-rank tests. Independent risk factors for PFS and OS were analyzed using a Cox proportional hazards model. Results Thirty-five patients received TACE–iodine-125 and 48 received TACE alone. The median OS and PFS were both significantly longer in the TACE–iodine-125 compared with the TACE-alone group (42 vs 23 months and 16 vs 8 months, respectively). The ORR was significantly higher in the TACE–iodine-125 compared with the TACE-alone group. There was no significant difference in adverse events, apart from decreased white cell count, between the two groups. Conclusion TACE–iodine-125 might be an effective and safe alternative treatment for patients with HCC (≤5 cm).

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