Pulmonary complications of transcatheter arterial chemoembolization for hepatocellular carcinoma

Abstract

Transarterial chemoembolization (TACE) is an effective palliative intervention that is widely accepted for the management of hepatocellular carcinoma (HCC). Post-TACE pulmonary complications resulting in acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) are rare events. Pulmonary complications after TACE are thought to be related to chemical injury subsequent to the migration of the infused ethiodized oil or chemotherapeutic agent to the lung vasculature, facilitated by arteriovenous (AV) shunts within the hyper-vascular HCC. We review herein the literature on pulmonary complications related to TACE for HCC. Post-TACE pulmonary complications have included pulmonary oil embolism, interstitial pneumonitis, chemical pneumonitis, ALI, ARDS, lipoid pneumonia, acute eosinophilic and neutrophilic pneumonia, bilious pleuritis, pulmonary abscess, pulmonary tumor embolism, and possibly pulmonary metastasis with HCC. The risk factors associated with post-TACE pulmonary complications identified in the literature include large hyper-vascular HCC with AV shunts, large-volume Lipiodol infusion, and embolization via the right inferior phrenic artery. However, the absence of known risk factors is not a guarantee against serious complications. An astute awareness of the potential post-TACE pulmonary complications should expedite appropriate therapeutic interventions and increase potential for early recovery.

Drug-eluting beads transarterial chemoembolization sequentially combined with radiofrequency ablation in the treatment of untreated and recurrent hepatocellular carcinoma

“…Iezzi et al[ 29 ] reported that for patients with HCC > 3 cm, the long-term survival of RFA combined with TACE was better than that of TACE or RFA alone. It is worth noting that the traditional emulsion has poor stability, and the chemotherapeutic drugs are easily diffused into the patient's peripheral circulatory system, resulting in an uncontrolled local release of the drug, and easily reducing the local treatment effect and aggravating the systemic adverse reactions of the chemotherapeutic drugs[ 30 ].…”

Protective effect of breviscapine in acute pulmonary embolism rats via regulation ofMCP‐1 andIL‐13

“…Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has travelled from elsewhere in the body through the bloodstream,1 which results in between 50 000 and 200 000 deaths in United States every year 2…”

<p>Efficacy and Safety of Supplemental Transarterial Chemoembolization Through Extrahepatic Collateral Arteries with Drug-eluting Beads: Treatment for Unresectable Hepatocellular Carcinoma</p>

“…cTACE is applied in clinical practice with a longer period than DEB-TACE, thus articles focusing on the TACE of EHC blood supplies are limited to cTACE. [12][13][14][15] In the other words, the role of DEB-TACE in the treatment of EHC blood supplies of HCC is still undetermined.…”

“…Furthermore, no grade 3-4 liver toxicity was documented in all patients in our study, indicating that TACE of EHC arteries is safe with regard to liver function. The safety of transarterial management for HCC with the IPA has been evaluated in several studies, [12][13][14][15] and most of the adverse events were pulmonary complications, of which fewer than 5% met the definition for major complications. 13 In our study, DEB-TACE and cTACE showed no significant difference in both major and minor complications.…”

“…The safety of transarterial management for HCC with the IPA has been evaluated in several studies, [12][13][14][15] and most of the adverse events were pulmonary complications, of which fewer than 5% met the definition for major complications. 13 In our study, DEB-TACE and cTACE showed no significant difference in both major and minor complications. With regard to pulmonary complications, only one (2.4%) and two (10.5%) patients in DEB-TACE and cTACE groups respectively met the definition of major complications.…”