How to prophylactically alleviate postembolization syndrome following transarterial chemoembolization?

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.

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Postembolization Syndrome after Hepatic Transarterial Chemoembolization: Effect of Prophylactic Steroids on Postprocedure Medication Requirements

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2012.11.019 ◽

2013 ◽

Vol 24 (3) ◽

pp. 326-331 ◽

Cited By ~ 11

Author(s):

Matthew J. Kogut ◽

Rush H. Chewning ◽

William P. Harris ◽

Daniel S. Hippe ◽

Siddharth A. Padia

Keyword(s):

Transarterial Chemoembolization ◽

Postembolization Syndrome

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

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2017.07.021 ◽

2017 ◽

Vol 28 (11) ◽

pp. 1503-1511.e2 ◽

Cited By ~ 13

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

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

Acta Médica Portuguesa ◽

10.20344/amp.8976 ◽

2018 ◽

Vol 31 (1) ◽

pp. 22 ◽

Cited By ~ 7

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.

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

Therapeutic Advances in Medical Oncology ◽

10.1177/1758835919866072 ◽

2019 ◽

Vol 11 ◽

pp. 175883591986607 ◽

Cited By ~ 2

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.

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