Transarterial chemoembolisation in patients with hepatocellular carcinoma: low-dose doxorubicin reduces post-embolisation syndrome without affecting survival—prospective interventional study

Abstract

Background No chemotherapeutic agents have been standardised for transarterial chemoembolisation (TACE). In particular, doxorubicin has no defined optimal dosage in TACE procedures. We compared low versus currently used dose of doxorubicin for TACE in patients with hepatocellular carcinoma (HCC) in terms of severity of post-embolisation syndrome (PES) and overall survival (OS). Methods From October 2014 to March 2018, we enrolled patients with primary HCC scheduled for TACE. Patients were randomised to receive 50 mg (group A) or 100 mg (group B) of doxorubicin. Outcomes were the rate of patients with PES; free-time-to-PES; changes in laboratory results; tumour response at 1, 3, and 6 months after TACE; and overall survival. Results Twenty-eight patients (24 males, 4 females) were enrolled, aged 58.9 ± 6.8 years (mean ± standard deviation). Fifteen of them palliated with 50 mg (group A) and 13 with 100 mg (group B) of doxorubicin for a total of 68 TACE procedures (of 28 patients who had repeated TACE procedures). Visual analogue scale (VAS) and duration of pain were significantly differently lower in group A than in group B (p < 0.001). The median duration of fever was shorter in group A than in group B (p = 0.003). No significant differences between both groups were observed for tumour response to TACE and OS. The doxorubicin dose was significantly correlated with duration of pain, fever, and VAS score. Conclusion A lower dose of doxorubicin (50 mg) was associated with fewer PES symptoms compared with 100 mg, without effects on tumour response nor OS.

Determining Risk Factors for Post-Embolization Syndrome in Patients Undergoing TACE for Hepatic Malignancies

“…Up to date, there is no established optimal dosage for doxorubicin in TACE procedures (19). In this study, it was found that a higher dose of doxorubicin was significantly associated with the occurrence of PES, suggesting that medication management could be a key area for reducing PES risk.…”

TACE for HCC: A critical review of the 2021 CIRSE recommendations with presentation of a technique for a degradable starch microsphere—TACE

“…This term includes symptoms, such as pain, nausea, vomiting and fever, that occur after the treatment. The incidence of these symptoms ranges from 20% to 80% 25,26 . According to the available data, the type of embolic agent (permanent or temporary 25 ), the dose of the chemotherapeutic agent and the size and numbers of the liver tumours play a role 26 .…”

“…The incidence of these symptoms ranges from 20% to 80%. 25,26 According to the available data, the type of embolic agent (permanent or temporary 25 ), the dose of the chemotherapeutic agent and the size and numbers of the liver tumours play a role. 26 However, there are no controlled studies on this complex topic.…”

Efficacy and safety analysis of dexamethasone + palonosetron in prevention of post-embolization syndrome after D-TACE: A retrospective study

“…D-TACE is the use of drug-eluting microspheres loaded with chemotherapeutic drugs for tumor embolization, which has been widely used in clinic in recent years. The most common side effect after D-TACE is post-embolization syndrome, [7,8] including All participants information, images and inspection results are agreed to be published and have obtained informed consent. The details, images will be freely available on the internet and may be seen by the general public.…”