Identifying predictors and evaluating the role of steroids in the prevention of post-embolization syndrome after transarterial chemoembolization and bland embolization

Abstract

Background Transarterial chemoembolization (TACE) and bland embolization (TAE), performed for hepatocellular carcinoma (HCC), are often complicated by post-embolization syndrome (PES). There are limited data regarding the incidence of PES after TAE and the role of steroids in PES. We report the incidence of PES post TACE and TAE, identify predictors, and evaluate the role of steroids in PES. Methods Demographic and clinical variables of patients who underwent embolization were collected and PES was identified. Risk factors for PES, TACE and TAE were derived by logistic regression. We compared patients who received dexamethasone to those who did not, regarding baseline characteristics, occurrence of PES, and hospital stay. Results A total of 171 patients, average age 60.5 years, underwent the procedure, 77.8% were male, and 87.7% had cirrhosis. Of these 171, 107 underwent TACE and 64 TAE. Dexamethasone was given to 106 (61.9%) patients, of whom 85 had TACE and 21 TAE. One hundred twenty-four patients (72.5%) developed PES. PES occurred in more patients who underwent TACE, 80 (74.7%) vs. 44 (68.7%), and resulted in a longer hospital stay (1.47 vs. 1.12 days, P=0.034). Predictive factors for PES included female sex (odds ratio [OR] 2.76, 95% confidence interval [CI] 1.04-7.34; P=0.041), and alcohol-related HCC (OR 3.14, 95%CI 1.42-6.95; P=0.005). Dexamethasone did not affect the length of hospital stay (1.43 vs. 1.29 days, P=0.422) or the rate of prolonged hospitalization (18.8% vs. 15.4%, P=0.561). Conclusion There was no difference in the incidence of PES following TACE or TAE and the use of dexamethasone did not reduce the incidence of PES or the duration of hospital stay.

Efficacy of High-Dose Dexamethasone in Reducing the Symptoms of Postembolization Syndrome Following Prostatic Artery Embolization: Results of a Double-Blind Randomized Controlled Trial

“…Additionally, methylprednisolone reduced the inflammatory response and pain after other interventional radiology procedures, such as endovascular aortic repair and transarterial chemoembolization of the liver (TACE) [ 9 , 16 ]. On the other hand, two other TACE studies in 171 and 125 patients showed no effect of dexamethasone on the severity of PES symptoms [ 17 , 18 ].…”

Transarterial Chemoembolization for Hepatocellular Carcinoma: Why, When, How?

“…This post-embolization syndrome (PES) presents with fever, right upper quadrant abdominal pain, and nausea with or without vomiting [ 36 ]. PES is associated with prolonged hospital stays and recurrent admissions, but it is also considered an early predictor of worse overall survival [ 36 , 37 ]. Prophylactic administration of steroids and 5-HT3 receptor antagonists has been used to prevent PES [ 38 ].…”

Pharmacokinetic study comparing doxorubicin concentrations after chemoembolization or intravenous administration in dogs with naturally occurring nonresectable hepatic carcinoma

“…Postembolization syndrome, a commonly described adverse event after DEB-TACE in humans that consists of nausea, fever, fatigue, and abdominal pain, 18,19 was characterized as either occurring or not occurring after NO STASIS or STASIS treatments. In our patient population, diarrhea was included as a clinical sign attributable to PES based on our experience of performing these procedures with and without chemotherapy.…”