A new horizon in the prevention of the postembolization syndrome after transcatheter arterial chemoembolization for hepatocellular carcinoma

Piscaglia, Fabio; Tovoli, Francesco; Pini, Paolo; Salvatore, Veronica

doi:10.1002/hep.29517

Cited by 15 publications

(10 citation statements)

References 8 publications

(15 reference statements)

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“…However, the main limitation of our study was the small sample size of the included patients which limits the generalisation of our findings. Generally, patients with a large tumour size tend to suffer more from PES [29]. However, although in this study we did not find significant differences between the groups regarding the total size of the masses, we did not find a significant correlation between tumour size and severity of PES symptoms.…”

Section: Discussioncontrasting

confidence: 90%

“…The main endpoint to study the benefit of techniques and methods for the treatment of HCC is OS and other methods of assessment including local response, time to progression of disease, and disease-free survival [31]. Another important endpoint for TACE, i.e., the cumulative absence of fever, nausea, vomiting, and anorexia, can be considered as an important endpoint for TACE procedures [29].…”

Section: Discussionmentioning

confidence: 99%

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Transarterial chemoembolisation in patients with hepatocellular carcinoma: low-dose doxorubicin reduces post-embolisation syndrome without affecting survival—prospective interventional study

et al. 2021

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Background No chemotherapeutic agents have been standardised for transarterial chemoembolisation (TACE). In particular, doxorubicin has no defined optimal dosage in TACE procedures. We compared low versus currently used dose of doxorubicin for TACE in patients with hepatocellular carcinoma (HCC) in terms of severity of post-embolisation syndrome (PES) and overall survival (OS). Methods From October 2014 to March 2018, we enrolled patients with primary HCC scheduled for TACE. Patients were randomised to receive 50 mg (group A) or 100 mg (group B) of doxorubicin. Outcomes were the rate of patients with PES; free-time-to-PES; changes in laboratory results; tumour response at 1, 3, and 6 months after TACE; and overall survival. Results Twenty-eight patients (24 males, 4 females) were enrolled, aged 58.9 ± 6.8 years (mean ± standard deviation). Fifteen of them palliated with 50 mg (group A) and 13 with 100 mg (group B) of doxorubicin for a total of 68 TACE procedures (of 28 patients who had repeated TACE procedures). Visual analogue scale (VAS) and duration of pain were significantly differently lower in group A than in group B (p < 0.001). The median duration of fever was shorter in group A than in group B (p = 0.003). No significant differences between both groups were observed for tumour response to TACE and OS. The doxorubicin dose was significantly correlated with duration of pain, fever, and VAS score. Conclusion A lower dose of doxorubicin (50 mg) was associated with fewer PES symptoms compared with 100 mg, without effects on tumour response nor OS.

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Section: Discussioncontrasting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Transarterial chemoembolisation in patients with hepatocellular carcinoma: low-dose doxorubicin reduces post-embolisation syndrome without affecting survival—prospective interventional study

et al. 2021

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“…The most common adverse events were related to the postembolization syndrome, and included liver enzyme abnormalities (18.1%), fever (17.2%), abdominal pain (11.0%), vomiting (6.0%), and nausea (1.7%). Recently, the incidence of postembolization syndrome was shown to be reduced by a short course of steroids [39], but external validation and effects on oncological outcomes in larger populations with longer follow-up are required before such prophylaxis can be fully endorsed [40]. Hematological/bone marrow toxicity occurred in 13.5% of patients.…”

Section: Complications and Contraindications Of Tacementioning

confidence: 99%

Patient Selection for Transarterial Chemoembolization in Hepatocellular Carcinoma: Importance of Benefit/Risk Assessment

2018

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Background: Liver cancer is the second most common cause of cancer-related death, with hepatocellular carcinoma (HCC) accounting for most primary liver cancers and most commonly arising from a history of advanced chronic liver disease. Among the available therapies, transarterial chemoembolization (TACE) is the most widely utilized and is considered the first-line treatment recommended for patients staged as intermediate HCC (Barcelona Clinic Liver Cancer stage B). If applied correctly, TACE can produce survival benefits without adversely affecting hepatic functional reserve. Summary: The aim of this nonsystematic review is to evaluate the evidence supporting TACE, with a special interest in intermediate HCC, for which this treatment is recommended in first line. However, intermediate HCC represents a broad and heterogeneous group of patients, not all of whom will benefit from TACE. This review highlights the importance of appropriate patient selection for initial TACE and for retreatment. It also evaluates evidence for the treatment of patients who become refractory to TACE. Some patients may, in fact, benefit from early switch (i.e., after 1 or 2 TACE treatments) to systemic therapies rather than continuing retreatments with TACE in order to preserve liver function, thus allowing sequential first- and second-line drug therapies. Key Messages: Careful assessment of an individual patient's benefit/risk ratio is recommended before any TACE session is considered to ensure optimal long-term outcomes in intermediate HCC.

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“… 30 This collection of symptoms is often referred to as the post-embolization syndrome, which is thought to be due to systemic cytokine release. 58 More serious adverse effects of c-TACE are less common, but include hepatic artery complications (7.2%), new ascites (6.1%), hepatic decompensation or failure (1.0%), hepatic abscess (0.9%), and acute renal impairment (0.6%). 30 Patients with more advanced liver disease or biliary obstruction are at increased risk of serious complications.…”

Section: Standard Management Of Intermediate Stage Hcc: Tacementioning

confidence: 99%

Management of patients with intermediate stage hepatocellular carcinoma

Prince

Liu

et al. 2020

Ther Adv Med Oncol

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Hepatocellular carcinoma (HCC) causes a significant health burden globally and its impact is expected to increase in the coming years. Intermediate stage HCC, as defined by the Barcelona Clinic Liver Cancer (BCLC) system stage B, represents up to 30% of patients at diagnosis and encompasses a broad spectrum of tumor burden. Several attempts have been made to further subclassify this heterogenous group. The current standard of care recommended by BCLC for intermediate stage HCC patients is transarterial chemoembolization (TACE), with modest outcomes reported. While refinements have been made to TACE technique and patient selection, it remains non-curative. In the real-world setting, only 60% of patients with intermediate stage HCC receive TACE, with the remainder deviating to a range of other therapies that have shown promise in select patient subgroups. These include curative treatments (resection, ablation, and liver transplantation), radiotherapy (stereotactic and radioembolization), systemic therapies, and their combination. In this review, we summarize the classifications and current management for patients with intermediate stage HCC as well as highlight recent key developments in this space.

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A new horizon in the prevention of the postembolization syndrome after transcatheter arterial chemoembolization for hepatocellular carcinoma

Cited by 15 publications

References 8 publications

Transarterial chemoembolisation in patients with hepatocellular carcinoma: low-dose doxorubicin reduces post-embolisation syndrome without affecting survival—prospective interventional study

Transarterial chemoembolisation in patients with hepatocellular carcinoma: low-dose doxorubicin reduces post-embolisation syndrome without affecting survival—prospective interventional study

Patient Selection for Transarterial Chemoembolization in Hepatocellular Carcinoma: Importance of Benefit/Risk Assessment

Management of patients with intermediate stage hepatocellular carcinoma

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