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Song PW, Liu YH, Wang T, Yu L, Liu JL. Construction of pain prediction model for patients undergoing hepatic arterial chemoembolization. World J Surg Oncol 2023; 21:100. [PMID: 36941629 PMCID: PMC10026457 DOI: 10.1186/s12957-023-02986-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE To construct a predictive model for pain in patients undergoing hepatic arterial chemoembolization (TACE) in interventional operating room. METHODS Through literature review and expert interviews, a questionnaire was prepared for the assessment of pain factors in patients with hepatic arterial chemoembolization. A prospective cohort study was used to select 228 patients with hepatic arterial chemoembolization in a tertiary and first-class hospital. The data of the patients in the pain group and the non-pain group were compared, and a rapid screening prediction model was constructed by univariate analysis and logistic regression analysis, and its prediction effect was tested. RESULTS Tumor size, liver cancer stage, and chemoembolization with drug-loaded microspheres and pirarubicin hydrochloride (THP) mixed with lipiodol were independent predictors of pain in patients after hepatic arterial chemoembolization. Finally, the pain prediction model after TACE was obtained. The results of Hosmer-Lemeshow test showed that the model fit was good (χ2 = 13.540, p = 0.095). The area under the receiver operating characteristic curve was 0.798, p < 0.001. CONCLUSION The rapid screening and prediction model of pain in patients undergoing hepatic arterial chemoembolization has certain efficacy, which is helpful for clinical screening of patients with high risk of pain, and can provide reference for predictive pain management decision-making.
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Affiliation(s)
- Ping-Wei Song
- Surgical Department 1, Yantai Yuhuangding Hospital, Yantai, 264000, China
| | - Ye-Hui Liu
- Department of Interventional Therapy, Yantai Yuhuangding Hospital, Yantai, 264000, China
| | - Tao Wang
- Department of Interventional Therapy, Yantai Yuhuangding Hospital, Yantai, 264000, China
| | - Lei Yu
- Surgical Department 1, Yantai Yuhuangding Hospital, Yantai, 264000, China
| | - Jing-Li Liu
- Catheterization Room, Yantai Yuhuangding Hospital, No. 20 Yuhuangding East Road, Zhifu District, Yantai, 264000, China.
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Wang LZ, Hu XX, Shen XC, Wang TC, Zhou S. Intraarterial Lidocaine Administration for Pain Control by Water-in-Oil Technique in Transarterial Chemoembolization: in vivo and Randomized Clinical Trial. J Hepatocell Carcinoma 2021; 8:1221-1232. [PMID: 34676180 PMCID: PMC8502067 DOI: 10.2147/jhc.s331779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/23/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the sustained release of lidocaine from a lidocaine–epirubicin–lipiodol emulsion created by water-in-oil (W/O) technique in vivo and evaluate the efficacy and safety of intraarterial lidocaine administration for intra- and postoperative pain control in transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Methods The in vivo concentrations of lidocaine were determined in tumor tissues after VX2 rabbit models for hepatic tumor were administered with intra-arterial lidocaine–epirubicin–lipiodol emulsion. A prospective randomized controlled clinical trial was performed, enrolling 70 consecutive patients who underwent TACE. Patients were randomized into two groups: Group A received an immediate bolus intraarterial lidocaine injection before TACE, and Group B received a lidocaine–epirubicin–lipiodol emulsion during TACE. Pain intensity was compared between the two groups using a visual analog scale (VAS) score before (Tbefore) and at 0 h (T0), 4 h (T4), 8 h (T8), 24 h (T24), 48 h (T48), and 72 h (T72) after the procedure. Adverse events and intake of analgesics were evaluated and compared between the two groups. Results The concentrations of lidocaine in tumor tissues were higher in experimental group than in control group at T0.5 (P=0.004), T1 (P=0.038), T4 (P=0.036), and T8 (P=0.029). In the clinical trial, VAS scores in Group B were significantly lower than in Group A at T0 (P=0.006), T4 (P=0.001), T8 (P=0.002), and T24 (P=0.005). The tramadol intake in Group B was significantly lower than in Group A (P=0.021). No significant difference was observed regarding the incidence of adverse events between the two groups. Conclusion This study demonstrated the effectiveness and safety of intraarterial lidocaine administration using the W/O technique in controlling intra- and post-TACE pain.
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Affiliation(s)
- Li-Zhou Wang
- Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Xiao-Xia Hu
- The State Laboratory of Functions and Application of Medicinal Plants, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Xiang-Chun Shen
- The State Laboratory of Functions and Application of Medicinal Plants, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China.,School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Tian-Cheng Wang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Shi Zhou
- Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
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Mortensen HR, Villadsen GE, Worm ES, Weber B. Survival and morbidity following stereotactic radiotherapy of hepatocellular carcinoma: a ten-year, single institution experience. Scand J Gastroenterol 2021; 56:259-265. [PMID: 33430663 DOI: 10.1080/00365521.2020.1869822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Stereotactic ablative body radiotherapy (SABR) is an emerging treatment option in hepatocellular carcinoma (HCC) in patients ineligible for other local ablative therapies. This study reports on the safety and efficacy of SABR in a Danish cohort of HCC patients. MATERIALS AND METHODS Between January 2009 and December 2018, 28 patients with HCCs were treated with SABR at our institution. The primary endpoint of this retrospective study was local control; secondary endpoints were progression-free survival, overall survival and toxicity. RESULTS In 28 patients, 32 tumors (median size 3.7 cm, range 1.4-6.8 cm) were treated. The median follow-up time was 16 months. Most patients (68%) received previous liver-directed treatments. A dose of 48 Gy in three or six fractions were given to 43% of the patients. Grad 1 or 2 toxicity was reported in 13 patients (46%), whereas 4 patients (14%) needed hospitalization (grade 3). One-year local control and overall survivals were 90% and 71%, respectively. One-year progression-free survival was 32%, and 65% of patients with disease progression received further HCC therapy. In univariate analysis, none of the examined factors predicted recurrence or overall survival. CONCLUSION SABR provides high local control to inoperable HCC. SABR can be delivered safely even after previous liver-directed therapies and subsequent therapies are feasible after treatment with SABR. Despite excellent local control, disease progression outside of the irradiated site remains prominent. Further studies are warranted to examine combined therapy approaches to maximize disease control.
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Affiliation(s)
- Hanna Rahbek Mortensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.,Danish Center of Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Esben Schjødt Worm
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Britta Weber
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.,Danish Center of Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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Wang TC, Zhang ZS, Xiao YD. Determination of Risk Factors for Pain After Transarterial Chemoembolization with Drug-Eluting Beads for Hepatocellular Carcinoma. J Pain Res 2020; 13:649-656. [PMID: 32273750 PMCID: PMC7108874 DOI: 10.2147/jpr.s246197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/06/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose To identify risk factors for pain after transarterial chemoembolization with drug-eluting beads (DEB-TACE) for hepatocellular carcinoma (HCC). Patients and Methods In this retrospective study, a total of 118 consecutive patients who underwent DEB-TACE between June 2016 and May 2019 with post-TACE pain were included. The patients were divided into three groups based on the severity of post-TACE pain according to the distribution of pain Visual Analogue Scale/Score (VAS). Potential risk factors for post-TACE pain were primarily analyzed using the chi-square test, one-way analysis of variance, or Kruskal–Wallis test (if appropriate). For multivariate analysis, an ordinal logistic regression model was utilized. Variables with P<0.10 in the univariate analysis were included in a multivariate model to identify independent risk factors for post-TACE pain. A multivariate analysis was also performed by means of a decision tree using the Classification and Regression Tree (CART) algorithm. Results The univariate analysis showed that elderly patients or patients with portal venous tumor thrombus (PVTT) were more likely to have severe post-TACE pain than young patients or those without PVTT (P=0.028 and <0.001, respectively). However, in the ordinal logistic regression, nonsuperselective chemoembolization and presence of PVTT were independent risk factors of severe post-TACE pain (P=0.046 and <0.001, respectively). In addition, the CART showed that nonsuperselective chemoembolization and PVTT could increase the probability of severe post-TACE pain. Conclusion Nonsuperselective chemoembolization and PVTT are independent risk factors for pain after DEB-TACE. Therefore, these factors should be taken into full consideration for the relief of pain.
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Affiliation(s)
- Tian-Cheng Wang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Zi-Shu Zhang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Yu-Dong Xiao
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
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Benzakoun J, Ronot M, Lagadec M, Allaham W, Garcia Alba C, Sibert A, Vilgrain V. Risks factors for severe pain after selective liver transarterial chemoembolization. Liver Int 2017; 37:583-591. [PMID: 27529160 DOI: 10.1111/liv.13235] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/11/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND & AIMS Post-procedural pain is frequent after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), and is only partially prevented by treatment selectivity. Our aim was to determine the risk factors of severe pain after selective TACE for HCC. METHODS From January 2012 to June 2014, all treatment-naïve patients undergoing a first selective TACE were included. Risk factors for severe pain, that is, the need for opioid analgesics (grade II-III), were identified by uni- and multivariate analysis. Internal validation of a logistic regression model for prediction of opioid intake was done with bootstrapping. RESULTS We analysed 335 tumours (mean 47 ± 37 mm) in 159 patients (131 men), mean 63.4 years old (20-92). Twenty-seven patients (17%) requested opioids. In univariate analysis, opioid intake was associated with young age (P=.021), doxorubicin dose received (P=.031), large HCC (P=.038), absence of chronic liver disease (P<.001) and alpha-foetoprotein levels (P=.03). In multivariate analysis, opioid intake was associated with young age (OR=0.65 per 10 years increment, P=.048), absence of chronic liver disease (OR=31.7, P<.001) and a higher fraction of the doxorubicin dose (OR=1.32 per 10% increment, P=.009). The optimism-corrected area under the curve of the prediction model for opioid intake using these three factors was 0.751. CONCLUSION In patients with HCC treated with TACE, selective procedure does not always prevent from severe pain. Young patients without chronic liver disease may be more susceptible to severe pain.
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Affiliation(s)
| | - Maxime Ronot
- Radiology, Beaujon Hospital, Clichy, France.,University Paris Diderot, Paris, France
| | - Matthieu Lagadec
- Radiology, Beaujon Hospital, Clichy, France.,University Paris Diderot, Paris, France
| | | | | | | | - Valérie Vilgrain
- Radiology, Beaujon Hospital, Clichy, France.,University Paris Diderot, Paris, France
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Rostambeigi N, Dekarske AS, Austin EE, Golzarian J, Cressman EN. Cost effectiveness of radioembolization compared with conventional transarterial chemoembolization for treatment of hepatocellular carcinoma. J Vasc Interv Radiol 2014; 25:1075-84. [PMID: 24861664 DOI: 10.1016/j.jvir.2014.04.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 04/18/2014] [Accepted: 04/18/2014] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To assess cost effectiveness of radioembolization versus conventional transarterial chemoembolization. MATERIALS AND METHODS The cost of radioembolization versus conventional transarterial chemoembolization was determined based on Medicare reimbursements. Three patient subgroups were defined based on the Barcelona Clinic Liver Cancer (BCLC) classification system (A, B, or C). Efficacy and safety outcomes after each procedure were obtained from the literature. A Monte Carlo case-based simulation was designed for 60 months in 250 patients in each subgroup. Survival was calculated based on average survival from the literature and the Monte Carlo model. The primary outcome was the cost effectiveness of radioembolization over transarterial chemoembolization by considering calculated survival. RESULTS The costs approached $17,000 for transarterial chemoembolization versus $31,000 or $48,000 for unilobar or bilobar radioembolization, respectively. Based on the simulation, median estimated survival was greater with transarterial chemoembolization than radioembolization in BCLC-A and BCLC-B subgroups (40 months vs 30 months and 23 months vs 16 months, respectively, P = .001). However, in the BCLC-C subgroup, survival was greater with radioembolization than transarterial chemoembolization (13 months vs 17 months, P = .001). The incremental cost-effectiveness ratio of radioembolization over transarterial chemoembolization in the BCLC-C subgroup was $360 per month. The results were dependent on bilobar versus unilobar radioembolization and the total number of radioembolization procedures. CONCLUSIONS The model suggests radioembolization costs may be justified for patients with BCLC-C disease, whereas radioembolization may not be cost effective in patients with BCLC-A disease; however, many patients with BCLC-C disease have extensive disease precluding locoregional therapies. Secondary considerations may determine treatment choice in more borderline patients (BCLC-B disease) because there is no persistent survival benefit with radioembolization.
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Affiliation(s)
- Nassir Rostambeigi
- Department of Radiology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455.
| | - Adrienne S Dekarske
- Department of Radiology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455
| | - Erin E Austin
- Department of Medicine, Cardiology Division, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455
| | - Jafar Golzarian
- Department of Radiology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455
| | - Erik N Cressman
- Department of Radiology, MD Anderson Cancer Center, University of Texas, Houston, Texas
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