Side Effect/Complication Risk Related to Injection Branch Level of Chemoembolization in Treatment of Metastatic Liver Lesions from Colorectal Cancer

Abstract

Purpose: Transarterial chemoembolization with drug eluting beads (DEB-TACE) loaded with irinotecan despite having proven efficacy in the treatment of unresectable liver metastases in the course of colorectal cancer (CRC) does not have an established consistent method. In particular, there are discrepancies in the branch level at which microspheres are administered. Lobar embolization supplies microspheres to all vessels supplying a metastatic lesion but exposes the entire liver parenchyma to negative effects from microsphere irinotecan. Superselective chemoembolization compromises healthy liver parenchyma less but may omit small vessels supplying metastatic lesions. Objective: Assessment of the risk of complications and the severity of postembolization syndromes with CRC metastatic liver lesion chemoembolization with irinotecan-loaded microspheres, according to branch level of chemoembolization. Patients and methods: The analysis included 49 patients (27 female/22 male) with liver metastases in the course of CRC, who underwent 192 chemoembolization treatments (mean 3.62 per patient) with microspheres loaded with 100 mg irinotecan. The procedures were performed according to an adopted schema: alternating the right and left lobe of the liver at 3-week intervals. The severity of postembolization syndrome (PES) and the presence of complications were assessed according to the branch level of chemoembolization; microspheres were administered at the branch level of lobar, segmental, or subsegmental arteries. Assessment of adverse events was performed according to the standards of the Cancer Therapy Evaluation Program Common Terminology Criteria for Adverse Events, Version 5.0. Results: The median survival of all patients from the start of chemoembolization was 13 months. With 192 chemoembolization sessions, 14 (7.3%) serious complications were found. The study showed no significant relationship between the branch level of embolizate administration and the presence of complications (p = 0.2307). Postembolization syndrome was diagnosed after 102 chemoembolization treatments, i.e., 53.1% of treatments. A significant correlation was found between the severity of the postembolization syndrome and the branch level of embolization treatment (p = 0.00303). The mean PES severity increased from subsegmental through segmental to lobar administration. Conclusion: Chemoembolization using Irinotecan-loaded microspheres was relatively well tolerated by patients and gave a low risk of significant complications, which did not change with the branch level of microsphere administration. However, an association was found between the branch level of chemoembolization and the severity of postembolization syndrome. Further research is needed to determine the most effective DEB-TACE chemoembolization technique.

Multidisciplinary collaboration for the successful treatment of a giant hepatic solitary fibrous tumor protruding into the thorax: A case report

“…To avoid the occurrence of serious complications, selective catheterization and slow infusion of the embolic material were performed in the present case. In addition, the results of a previous study demonstrated that post-embolization syndrome is closely associated with the side effects of chemotherapy drugs ( 49 ). Thus, self-made gelatin sponges were used in the present study to replace the chemotherapy drugs and result in fewer side effects.…”

Safety, Feasibility and Technical Considerations from a Prospective, Observational Study—CIREL: Irinotecan-TACE for CRLM in 152 Patients

“…Irinotecan-TACE is generally well tolerated with serious adverse events (AEs) experienced in about 0–10% of patients [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. However, grade 1 and 2 post-embolization syndrome (PES) after a treatment session is a common occurrence (10–60%) [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Although there are recommendations regarding treatment plans [ 25 , 26 ], such as to perform at least two sessions for unilobar and four sessions for bilobar disease and regarding technical considerations like the use of opioids, intra-arterial anesthetic, and antiemetics, recent literature has highlighted the lack of standardized technical protocols [ 11 ].…”