Safety and Feasibility of Same-Day Discharge of Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization with Drug-Eluting Beads in a Liver Transplantation Program

Nasser, Felipe; Cavalcante, Rafael; Galastri, Francisco Leonardo; Rezende, Marcelo Bruno de; Felga, Guilherme Eduardo Gonçalves; Travassos, Fabiellen Berzoini; Fina, Bruna De; Affonso, Breno Boueri

doi:10.1016/j.jvir.2014.02.025

Cited by 19 publications

(10 citation statements)

References 22 publications

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“…The use of contemporary tools during TACE for hepatocellular carcinoma facilitated superselective catheterization with improved response and decreased toxicity (2)(3)(4)9,21). As demonstrated in our study and in other studies (6,7,9,22), TACE-related PES is often mild and self-limited. In a pilot study by Prajapati et al (6), the maximum mean pain score following TACE was 1.61 (scale of 1-10) allowing for early discharge after 85% of TACE procedures.…”

Section: Discussionsupporting

confidence: 87%

“…With the US health care expenditure outpacing the growth in the gross domestic product (11), it is critical for physicians to identify areas of opportunity for efficiency. A few previous studies (6,7,12) reported results regarding same-day discharge after TACE but had a narrow focus on establishing safety, and they lack analysis of patient characteristics, individual laboratory parameters, and procedural variables as predictors of recovery. The objective of this study was to use statistical tools to create and validate a comprehensive predictive model for PES in patients undergoing TACE for hepatocellular carcinoma.…”

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confidence: 99%

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A Predictive Model for Postembolization Syndrome after Transarterial Hepatic Chemoembolization of Hepatocellular Carcinoma

et al. 2019

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To develop and validate a predictive model for postembolization syndrome (PES) following transarterial hepatic chemoembolization (TACE) for hepatocellular carcinoma. Materials and Methods: In this single-center, retrospective study, 370 patients underwent 513 TACE procedures between October 2014 and September 2016. Seventy percent of the patients were randomly assigned to a training data set and the remaining 30% were assigned to a testing data set. Variables included demographic, laboratory, clinical, and procedural details. PES was defined as pain and/or nausea beyond 6 hours after TACE that required intravenous medication for symptom control. The predictive model was developed by using conditional inference trees and Lasso regression. Results: Demographics, laboratory data, performance, tumor characteristics, and procedural details were statistically similar for the training and testing data sets. Overall, 83 of 370 patients (22.4%) after 107 of 513 TACE procedures (20.8%) met the predefined criteria. Factors identified at univariable analysis included large tumor burden (P = .004), drug-eluting embolic TACE (P = .03), doxorubicin dose (P = .003), history of PES (P , .001) and chronic pain (P , .001), of which history of PES, tumor burden, and drug-eluting embolic TACE were identified as the strongest predictors by the multivariable analysis and were used to develop the predictive model. When applied to the testing data set, the model demonstrated an area under the curve of 0.62, sensitivity of 79% (22 of 28), specificity of 44.2% (53 of 120), and a negative predictive value of 90% (53 of 59). Conclusion: The model identified history of postembolization syndrome, tumor burden, and drug-eluting embolic chemoembolization as predictors of protracted recovery because of postembolization syndrome.

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Section: Discussionsupporting

confidence: 87%

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confidence: 99%

A Predictive Model for Postembolization Syndrome after Transarterial Hepatic Chemoembolization of Hepatocellular Carcinoma

et al. 2019

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“…Mitchell et al 20 reported the safety of the outpatient concept in carefully selected patients, where 131 from 133 sessions were performed on outpatient cases and only 2 required readmission. Nasser et al 21 also reported the safety of treating the patients on outpatient basis. In our experience, most patients can be treated on outpatient basis; hospital stay is required in case of complications.…”

Section: Current Trends In Interventional Treatment Of Colorectal Canmentioning

confidence: 99%

Current strategies in interventional oncology of colorectal liver metastases

Gruber‐Rouh

Marko

Thalhammer

et al. 2016

BJR

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The adequate treatment of non-resectable liver metastases from colorectal cancer which are resistant to systemic chemotherapy currently provides a great challenge. The aim is to identify and review key strategies in the treatment of colorectal liver metastases. A search for current literature on the topic of interventional strategies for colorectal metastases was performed in Medline in order to achieve this goal. Studies before 2005 and with ,20 patients treated for colorectal metastases were excluded. Transarterial chemoembolization (TACE), transarterial embolization and selective internal radiation therapy (SIRT) were identified as examples of regional strategies for colorectal liver metastases, utilizing the unique blood supply of the liver. Radiofrequency ablation (RFA), microwave ablation (MWA) and cryoablation were selected as examples for currently available ablative techniques. Median survival in the key studies reviewed ranged from 7.7 to 28.6 for TACE, 8.3-12.6 for SIRT, 8.2-53.2 for RFA and 29-43 months for MWA. After review of the literature, it can be concluded that interventional oncologic therapies are a safe and effective method for treating colorectal liver metastases. The use of new chemotherapeutic agents for local therapy and new ablation technologies and techniques may increase patient survival and allows a neoadjuvant therapy setting. In addition, a combination of local therapies may be used to increase effectiveness in the future, which is subject to further research. INTRODUCTIONColorectal cancer is one of the most common cancers that shows fatal progression.1 Colorectal carcinoma most commonly metastasises to the liver due to haematogenous spread.2 At the time of diagnosis, 20-30% of patients have liver metastases, and during the course of disease, up to 60% of patients develop hepatic metastases.3 Although surgical excision is the first-line treatment for colorectal metastases, only 10-25% of patients are candidates for surgical resection. 4 Neoadjuvant systemic chemotherapy only allows 10-30% of patients with unresectable colorectal liver metastases sufficient downsizing for resection.

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“…The present study included 200 consecutive patients with HCC, from April 1, 2011 to June 30, 2014, who underwent DEB-TACE at our institution using the outpatient treatment protocol previously described[11]. These patients were part of the liver transplant program and were divided into two groups: Bridging and downstaging (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…DEB-TACE protocol was previously described by Nasser et al[11] and Cavalcante et al[14]. Briefly, DEB-TACE procedures were performed under local anesthesia with lidocaine 2%, sedation and analgesia, with venous administration of midazolam and fentanyl.…”

Section: Methodsmentioning

confidence: 99%

Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging

Affonso

Galastri

Motta-Leal-Filho

et al. 2019

WJG

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BACKGROUNDProspective study of 200 patients with hepatocellular carcinoma (HCC) that underwent liver transplant (LT) after drug-eluting beads transarterial chemoembolization (DEB-TACE) for downstaging versus bridging. Overall survival and tumor recurrence rates were calculated, eligibility for LT, time on the waiting list and radiological response were compared. After TACE, only patients within Milan Criteria (MC) were transplanted. More patients underwent LT in bridging group. Five-year post-transplant overall survival, recurrence-free survival has no difference between the groups. Complete response was observed more frequently in bridging group. Patients in DS group can achieve post-transplant survival and HCC recurrence-free probability, at five years, just like patients within MC in patients undergoing DEB-TACE.AIMTo determine long-term outcomes of patients with HCC that underwent LT after DEB-TACE for downstaging vs bridging.METHODSProspective cohort study of 200 patients included from April 2011 through June 2014. Bridging group included patients within MC. Downstaging group (out of MC) was divided in 5 subgroups (G1 to G5). Total tumor diameter was ≤ 8 cm for G1, 2, 3, 4 (n = 42) and was > 8 cm for G5 (n = 22). Downstaging (n = 64) and bridging (n = 136) populations were not significantly different. Overall survival and tumor recurrence rates were calculated by the Kaplan-Meier method. Additionally, eligibility for LT, time on the waiting list until LT and radiological response were compared.RESULTSAfter TACE, only patients within MC were transplanted. More patients underwent LT in bridging group 65.9% (P = 0.001). Downstaging population presented: higher number of nodules 2.81 (P = 0.001); larger total tumor diameter 8.09 (P = 0.001); multifocal HCC 78% (P = 0.001); more post-transplantation recurrence 25% (P = 0.02). Patients with maximal tumor diameter up to 7.05 cm were more likely to receive LT (P = 0.005). Median time on the waiting list was significantly longer in downstaging group 10.6 mo (P = 0.028). Five-year post-transplant overall survival was 73.5% in downstaging and 72.3% bridging groups (P = 0.31), and recurrence-free survival was 62.1% in downstaging and 74.8% bridging groups (P = 0.93). Radiological response: complete response was observed more frequently in bridging group (P = 0.004).CONCLUSIONTumors initially exceeding the MC down-staged after DEB-TACE, can achieve post-transplant survival and HCC recurrence-free probability, at five years, just like patients within MC in patients undergoing DEB-TACE.

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Safety and Feasibility of Same-Day Discharge of Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization with Drug-Eluting Beads in a Liver Transplantation Program

Cited by 19 publications

References 22 publications

A Predictive Model for Postembolization Syndrome after Transarterial Hepatic Chemoembolization of Hepatocellular Carcinoma

A Predictive Model for Postembolization Syndrome after Transarterial Hepatic Chemoembolization of Hepatocellular Carcinoma

Current strategies in interventional oncology of colorectal liver metastases

Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging

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