N-Acetylcysteine Prevents Post-embolization Syndrome in Patients with Hepatocellular Carcinoma Following Transarterial Chemoembolization

Siramolpiwat, Sith; Punjachaipornpon, Thanachai; Pornthisarn, Bubpha; Vilaichone, Ratha-Korn; Chonprasertsuk, Soonthorn; Tangaroonsanti, Anupong; Bhanthumkomol, Patommatat; Phumyen, Achara; Yasiri, Atipat; Kaewmanee, Mayurachat

doi:10.1007/s10620-019-05652-0

Cited by 9 publications

(14 citation statements)

References 24 publications

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“…28 Recently, intravenous NAC was found to reduce the incidence of PES but not decompensation. 16 In our study, we administered NAC in those patients in whom the transaminase levels had increased to more than 3-to 4-fold higher than normal, on day 1, after TACE. In these patients, there was significant reduction of AST and ALT levels.…”

Section: Discussionmentioning

confidence: 93%

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Role of N-acetyl Cysteine in Post-transarterial Chemoembolization Transaminitis in Hepatocellular Carcinoma: A Single-center Experience

Kedarisetty

Bal²,

Parida³

et al. 2021

Journal of Clinical and Experimental Hepatology

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Background: Transarterial chemoembolization (TACE) is the most common locoregional therapy for hepatocellular carcinoma (HCC). Postembolization syndrome is not an uncommon complication. At present, there is no specific treatment for management of this complication. We aimed to study the role of N-acetyl cysteine (NAC), an antioxidant, in management of this complication. Methods: In a prospective observational study, consecutive patients with HCC undergoing TACE from January 2016 to January 2017 were included. Patients with postembolization syndrome, defined as an elevation of transaminase levels more than 3-4 times the upper limit of normal, were administered intravenous NAC for 72 h (150 mg/kg for 1 h, then 12.5 mg/kg/h for 4 h, and continuous infusion 6.25 mg/h for the remaining 67 h). The other group received only supportive standard of care. The primary end point was reduction in post-TACE transaminitis. Results: Of 112 patients with HCC, 53 (47.3%) received NAC. The majority were cirrhotics in both the groups. Both groups were well matched in demographic, laboratory, and tumor characteristics. In the NAC group, there was significant reduction in Aspartate transaminase (AST) and Alanine transaminase (ALT) levels from day 1 to day 3 (p = 0.000) compared with the non-NAC group, with no significant change in bilirubin or international normalized ratio levels. The duration of hospital stay was similar in both the groups. None had any major adverse events to NAC. Conclusion: This is a prospective, single-center experience, showing that early initiation of N-acetyl cysteine in those with post-TACE embolization syndrome reduces the transaminase level significantly.

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Section: Discussionmentioning

confidence: 93%

“…15 To circumvent these inflammatory cascades, today there are some emerging data that antioxidants such as N-acetyl cysteine (NAC) may have a beneficial role. 16 With this background, we undertook this study to determine the efficacy of NAC in managing transaminitis after TACE.…”

mentioning

confidence: 99%

Role of N-acetyl Cysteine in Post-transarterial Chemoembolization Transaminitis in Hepatocellular Carcinoma: A Single-center Experience

Kedarisetty

Bal²,

Parida³

et al. 2021

Journal of Clinical and Experimental Hepatology

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“…Another single study from Thailand used N-acetylcysteine (NAC) given before and after TACE, which has antioxidant properties that could prevent liver injury among patients with acetaminophen overdose. NAC was able to reduce the incidence of PES from 48.2 to 26.4%[ 21 ]. However, NAC regimens use a high volume of saline infusion and NAC did not prevent post-TACE liver decompensation.…”

Section: Discussionmentioning

confidence: 99%

Single dose dexamethasone prophylaxis of postembolisation syndrome after chemoembolisation in hepatocellular carcinoma patient: A randomised, double-blind, placebo-controlled study

Sainamthip¹,

Kongphanich²,

Prasongsook³

et al. 2021

WJCC

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BACKGROUND Even in the immuno-oncology era, transcatheter arterial chemoembolisation (TACE) is the most effective way to treat intermediate stage hepatocellular carcinoma (HCC). Postembolisation syndrome (PES) is the most common side effect from TACE and there is still no standard prevention guideline. AIM To evaluate the efficacy of single dose intravenous dexamethasone regimen to prevent PES after TACE among patients with HCC. METHODS This study enrolled patients with HCC who had eligible indication for TACE without macrovascular invasion/extrahepatic metastasis. Patients were randomly assigned to either an intravenous single dose of dexamethasone 8 mg or placebo one hour before TACE. The primary outcome was a negative result of PES at 48 h after TACE, which was defined as score < 2 of Southwest Oncology Group toxicity coding criteria using fever, nausea, vomiting and pain to calculated. And the secondary end point was duration of admission between two groups. RESULTS One hundred patients were randomly assigned 1:1. Under intention-to-treat analysis, 49 patients were randomly assigned to the dexamethasone and 51 to the placebo groups. Both groups were similar for baseline characteristics. The negative PES rate was significantly higher in the dexamethasone group than in the placebo group (63.3% vs 29.4%; P = 0.005). Mean Southwest Oncology Group toxicity coding PES was 2.14 (95%CI: 1.41-2.8) vs 3.71 (95%CI: 2.97-4.45) between the dexamethasone and placebo groups, respectively. Cumulative incidence of fever was significantly lower in dexamethasone group with P < 0.001, pain, nausea and vomiting were also lower in the dexamethasone group compared with the placebo group ( P = 0.16, P = 0.11, and P = 0.49). The dexamethasone regimen was generally well tolerated by patients with HCC patients including those with hepatitis B virus infection and well-controlled diabetes mellitus. CONCLUSION Single dose dexamethasone was effective at preventing PES among patients with HCC treated with TACE. The study showed no adverse events of special interest related to dexamethasone.

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“…With regard to these factors, there were numerous reports on how to improve pain tolerance and reduce the effects of post-embolization syndrome after treatment. For example, the use of glucocorticoids, n-acetylcysteine, and even superselective embolization of tumor supplying arteries has been shown to lower the risk of postoperative embolism syndrome and relieve patients' postoperative pain [16][17][18]. However, there are still few studies on the risk factors of pain and poor tolerance after TACE.…”

Section: Discussionmentioning

confidence: 99%

Scoring system for predicting postoperative pain after transarterial chemoembolization treatment in liver cancer

Wang

Zeng

Salameen

et al. 2022

Preprint

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Purpose: Patients that experience severe postoperative pain are more reluctant to adhere the treatment. This study intends to identify the relevant risk factors and construct a scoring system for prediction. Materials and methods: Liver cancer patients that underwent the first TACE treatment at the Second Affiliated Hospital of Chongqing Medical University from January 2019 to December 2020 were collected. The 11-point numerical rating scale (NRS-11) was utilized to evaluate the patient's pain level. The patients were randomly divided into a training and a validation cohort. In the training cohort, the correlation between each parameter and the pain level after TACE was evaluated through logistic regression, and a risk prediction model was established. Finally, the predictive power of the model was verified in the validation cohort. Results: A total of 255 patients with liver cancer were included. In the training cohort, univariate analysis found postoperative pain was related to tumor number, tumor size, microsphere volume, and operation time. The above variables were then incorporated into the multivariate analysis to construct the prediction model, In the training and validation cohorts, the area under the curve (AUC) of the model used to predict moderate to severe pain response after TACE was 0.71 and 0.74, respectively. Additionally, we also created a nomogram for clinical use, patients with a total score greater than 72.90 are considered at a high risk of experiencing moderate to severe pain following TACE. Conclusion: This study successfully constructed and validated a scoring system for predicting moderate to severe pain after an initial TACE treatment.

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N-Acetylcysteine Prevents Post-embolization Syndrome in Patients with Hepatocellular Carcinoma Following Transarterial Chemoembolization

Cited by 9 publications

References 24 publications

Role of N-acetyl Cysteine in Post-transarterial Chemoembolization Transaminitis in Hepatocellular Carcinoma: A Single-center Experience

Role of N-acetyl Cysteine in Post-transarterial Chemoembolization Transaminitis in Hepatocellular Carcinoma: A Single-center Experience

Single dose dexamethasone prophylaxis of postembolisation syndrome after chemoembolisation in hepatocellular carcinoma patient: A randomised, double-blind, placebo-controlled study

Scoring system for predicting postoperative pain after transarterial chemoembolization treatment in liver cancer

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