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Song PW, Wang JL, Wang T, Zou HN, Liu YH. Creating and Testing a Model to Predict Postoperative Discomfort in Patients with Hepatocellular Carcinoma Receiving Transarterial Chemoembolisation. HEPATITIS MONTHLY 2023. [DOI: 10.5812/hepatmon-133918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Background: Abdominal pain is a frequent adverse event in patients with hepatocellular carcinoma (HCC) after transarterial chemoembolisation (TACE). However, there remains uncertainty regarding the determinants of post-TACE pain. Objectives: We aimed to create and verify a prediction model for postoperative pain in patients with HCC after TACE treatment. Methods: This prospective study included all patients with HCC undergoing TACE in our hospital. According to the time of treatment, the dataset was divided into two cohorts (development and validation) in a 3: 2 ratio. After TACE, the participants used a visual analog scale to quantify their pain level at rest over a 24-hour period. The age, gender, tumor location, tumor size and number, medication administration route, and presence of portal vein tumor thrombosis (PVTT) were recorded in all patients. Results: In total, 137 (mean age: 60.3 ± 10.1 years; 78.1% male) and 91 (mean age: 61.1 ± 10.5 years; 73.6% male) patients were included in the development and validation cohorts, respectively. Furthermore, 46.0% and 39.6% of the patients experienced acute moderate to severe pain after TACE in the development and validation cohorts, respectively. The tumor location, the drug delivery method, and the presence of PVTT were independently associated with post-TACE pain, all of which were combined to develop a prediction model based on a logistic equation. The discrimination of this risk score was satisfactory in both the development (area under the curve (AUC): 0.693, 95% confidence interval (CI): 0.609 to 0.769, P < 0.001) and validation (AUC: 0.652, 95% CI: 0.544 to 0.748, P = 0.002) cohorts. There was no significant difference between the two cohorts (difference: 0.042, 95% CI: -0.081 to 0.164, P = 0.506). The risk score had good specificity for predicting post-TACE pain in both the development (83.8% (95% CI: 73.4% to 91.3%)) and validation (76.4% (95% CI: 63.0% to 86.8%)) cohorts. Conclusions: The presence of PVTT, the tumor location, and the drug administration method were risk factors for post-TACE discomfort. A prediction model based on these risk factors was useful for identifying patients who were vulnerable to post-TACE pain. However, further studies are required to validate these findings and optimize the model’s performance.
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Khuntee W, Hanprasitkam K, Sumdaengrit B. Effect of music therapy on postembolization syndrome in Thai patients with hepatocellular carcinoma: A quasi-experimental crossover study. BELITUNG NURSING JOURNAL 2022; 8:396-404. [PMID: 37554492 PMCID: PMC10405647 DOI: 10.33546/bnj.2210] [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: 07/19/2022] [Revised: 08/20/2022] [Accepted: 10/07/2022] [Indexed: 08/10/2023] Open
Abstract
Background Postembolization syndrome (PES), including abdominal pain, nausea, and vomiting, are complications most severe on the first day after transarterial chemoembolization (TACE). Music therapy has been found to help manage pain. If pain, a cause of nausea and vomiting, can be relieved, then nausea and vomiting should also be reduced. Objectives This study aimed to examine the effect of music therapy on PES in patients with liver cancer after receiving TACE. Methods This study employed a quasi-experimental crossover design. The study was conducted at the inpatient units of a specialized hospital for cancer in Bangkok, Thailand, from March 2020 to October 2021. Thirty patients with liver cancer were purposively selected based on the pre-determined criteria. A change-over design was used to compare patients' changes in abdominal pain, nausea, and vomiting from the experimental period to the other control period. During the experimental period, music therapy was administered for 30 minutes on Day 0 after TACE, then twice a day in the morning and evening of Days 1 and 2 after TACE, and in the morning of Day 3 after TACE. During the control period, the patients used silent headphones. Data were analyzed using Wilcoxon signed ranks and Friedman tests. Results The participants perceived abdominal pain, nausea, and vomiting at a mild level during all periods. Pain scores in the music therapy period were significantly lower than those in the control period on Days 0, 1, and 2 after TACE (p <0.001, p <0.01, and p <0.001, respectively) and lower than at the baseline (p <0.001). There were no statistically significant differences in nausea and vomiting scores between the music therapy period and the control period on Days 0, 1, and 2 after TACE and no statistically significant differences at the baseline. Conclusion Music therapy effectively reduces mild pain among patients with liver cancer experiencing PES. This therapy can be used as a non-pharmacological treatment for nurses and other healthcare professionals in caring for patients with liver cancer.
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Affiliation(s)
- Wassana Khuntee
- Master of Nursing Science Program (Adult and Gerontological Nursing), Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | | | - Bualuang Sumdaengrit
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
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Agrawal R, Majeed M, Aqeel SB, Wang Y, Haque Z, Omar YA, Upadhyay SB, Gast T, Attar BM, Gandhi S. Identifying predictors and evaluating the role of steroids in the prevention of post-embolization syndrome after transarterial chemoembolization and bland embolization. Ann Gastroenterol 2021; 34:241-246. [PMID: 33654366 PMCID: PMC7903567 DOI: 10.20524/aog.2020.0566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023] Open
Abstract
Background Transarterial chemoembolization (TACE) and bland embolization (TAE), performed for hepatocellular carcinoma (HCC), are often complicated by post-embolization syndrome (PES). There are limited data regarding the incidence of PES after TAE and the role of steroids in PES. We report the incidence of PES post TACE and TAE, identify predictors, and evaluate the role of steroids in PES. Methods Demographic and clinical variables of patients who underwent embolization were collected and PES was identified. Risk factors for PES, TACE and TAE were derived by logistic regression. We compared patients who received dexamethasone to those who did not, regarding baseline characteristics, occurrence of PES, and hospital stay. Results A total of 171 patients, average age 60.5 years, underwent the procedure, 77.8% were male, and 87.7% had cirrhosis. Of these 171, 107 underwent TACE and 64 TAE. Dexamethasone was given to 106 (61.9%) patients, of whom 85 had TACE and 21 TAE. One hundred twenty-four patients (72.5%) developed PES. PES occurred in more patients who underwent TACE, 80 (74.7%) vs. 44 (68.7%), and resulted in a longer hospital stay (1.47 vs. 1.12 days, P=0.034). Predictive factors for PES included female sex (odds ratio [OR] 2.76, 95% confidence interval [CI] 1.04-7.34; P=0.041), and alcohol-related HCC (OR 3.14, 95%CI 1.42-6.95; P=0.005). Dexamethasone did not affect the length of hospital stay (1.43 vs. 1.29 days, P=0.422) or the rate of prolonged hospitalization (18.8% vs. 15.4%, P=0.561). Conclusion There was no difference in the incidence of PES following TACE or TAE and the use of dexamethasone did not reduce the incidence of PES or the duration of hospital stay.
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Affiliation(s)
- Rohit Agrawal
- Department of Medicine (Rohit Agrawal, Muhammad Majeed, Sheeba-Ba Aqeel, Zohaib Haque, Yazan Abu Omar, Shristi Banskota Upadhyay)
| | - Muhammad Majeed
- Department of Medicine (Rohit Agrawal, Muhammad Majeed, Sheeba-Ba Aqeel, Zohaib Haque, Yazan Abu Omar, Shristi Banskota Upadhyay)
| | - Sheeba-Ba Aqeel
- Department of Medicine (Rohit Agrawal, Muhammad Majeed, Sheeba-Ba Aqeel, Zohaib Haque, Yazan Abu Omar, Shristi Banskota Upadhyay)
| | - Yuchen Wang
- Division of Gastroenterology and Hepatology, Department of Medicine (Bashar Attar, Seema Gandhi)
| | - Zohaib Haque
- Department of Medicine (Rohit Agrawal, Muhammad Majeed, Sheeba-Ba Aqeel, Zohaib Haque, Yazan Abu Omar, Shristi Banskota Upadhyay)
| | - Yazan Abu Omar
- Department of Medicine (Rohit Agrawal, Muhammad Majeed, Sheeba-Ba Aqeel, Zohaib Haque, Yazan Abu Omar, Shristi Banskota Upadhyay)
| | - Shristi Banskota Upadhyay
- Department of Medicine (Rohit Agrawal, Muhammad Majeed, Sheeba-Ba Aqeel, Zohaib Haque, Yazan Abu Omar, Shristi Banskota Upadhyay)
| | - Thomas Gast
- Division of Radiology and Diagnostic Imaging (Thomas Gast), Cook County Health and Hospital System, IL, USA
| | - Bashar M Attar
- Division of Gastroenterology and Hepatology, Department of Medicine (Bashar Attar, Seema Gandhi)
| | - Seema Gandhi
- Division of Gastroenterology and Hepatology, Department of Medicine (Bashar Attar, Seema Gandhi)
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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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Cashman JN, Ng L. The management of peri- and postprocedural pain in interventional radiology: a narrative review. Pain Manag 2017; 7:523-535. [DOI: 10.2217/pmt-2017-0024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Interventional radiology encompasses a wide range of procedures and the degree of associated pain depends predominantly on the procedure being undertaken. Procedures may be painful during but not after the procedure, relatively painless during but painful after the procedure, or relatively painless during and after the procedure. However, there is a lack of good quality publications in interventional radiology that specifically address the subject of peri- and postprocedural pain management. Nevertheless, a variety of more or less complex protocols exist for intraprocedural sedation and for peri- and postprocedural analgesia. While weight-based protocols for procedural sedation have demonstrable benefit, protocols for postprocedural pain relief after major procedures have not been sufficiently rigorously evaluated.
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Affiliation(s)
- Jeremy N Cashman
- Department of Anaesthetics, St George's Hospital, Blackshaw Road, London SW17 0QT, England
| | - Lenny Ng
- Department of Anaesthetics, St George's Hospital, Blackshaw Road, London SW17 0QT, England
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Luz JHM, Luz PM, Martin HS, Gouveia HR, Levigard RB, Nogueira FD, Rodrigues BC, de Miranda TN, Mamede MH. DEB TACE for Intermediate and advanced HCC - Initial Experience in a Brazilian Cancer Center. Cancer Imaging 2017; 17:5. [PMID: 28166821 PMCID: PMC5295188 DOI: 10.1186/s40644-017-0108-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/19/2017] [Indexed: 01/13/2023] Open
Abstract
Background According to Barcelona Clinic Liver Cancer classification transarterial chemoembolization is indicated in patients with Hepatocellular Carcinoma in the intermediate stage. Drug-eluting microspheres can absorb and release the chemotherapeutic agent slowly for 14 days after its intra-arterial administration. This type of transarterial chemoembolization approach appears to provide at least equivalent effectiveness with less toxicity. Methods This is a prospective, single-center study, which evaluated 21 patients with intermediate and advanced hepatocellular carcinoma who underwent transarterial chemoembolization with drug-eluting microspheres. The follow up period was 2 years. Inclusion criteria was Child-Pugh A or B liver disease patients, intermediate or advanced hepatocellular carcinoma and performance status equal or below 2. Transarterial chemoembolization with drug-eluting microspheres was performed at 2-month intervals during the first two sessions. The third and subsequent sessions were performed according to the image findings on follow-up, on a “demand schedule”. Tumor response and time to progression were evaluated along the two-year follow up period. Results Of the 21 patients 90% presented with liver cirrhosis, 62% had Barcelona Clinic Liver Cancer stage B and 38% had Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma. Average tumor size was 6.9 cm. The average number of Transarterial chemoembolization with drug-eluting microspheres procedures was 3 with a total of 64 sessions. The predominant toxicity was mild. Liver function was not significantly affected in most patients. Two deaths occurred within 90 days after Transarterial chemoembolization with drug-eluting microspheres (ischemic hepatitis and hydropic decompensation). Technical success was achieved in 63 of 64 procedures. The mean hospital stay was 1.5 days. The progression free and overall survival at 1 and 2 years were 73.0% and 37.1%, 73.7% and 41.6%, respectively. Conclusion Transarterial chemoembolization with drug-eluting microspheres is able to deliver significant tumor response and progression free survival rate with acceptable toxicity. Larger studies are needed to identify exactly which subset of advanced hepatocellular patients may benefit from this treatment. Trial registration study ID ISRCTN16295622. Registered October 14th 2016. Retrospectively registered. Website registration: http://www.isrctn.com/ISRCTN16295622
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Affiliation(s)
- Jose Hugo Mendes Luz
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro, CEP 20230-130, Brazil.
| | - Paula M Luz
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Henrique S Martin
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro, CEP 20230-130, Brazil
| | - Hugo R Gouveia
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro, CEP 20230-130, Brazil
| | - Raphal Braz Levigard
- Department of Interventional Radiology, Radiology Division, Hospital Federal de Bonsucesso, Avenida Londres, 616, Bonsucesso, Rio de Janeiro, 21041-030, Brazil
| | - Felipe Diniz Nogueira
- Department of Interventional Radiology, Radiology Division, Hospital Federal de Bonsucesso, Avenida Londres, 616, Bonsucesso, Rio de Janeiro, 21041-030, Brazil
| | - Bernardo Caetano Rodrigues
- Department of Interventional Radiology, Radiology Division, Hospital Federal de Ipanema, Rua Antônio Parreiras, 67, Ipanema, Rio de Janeiro, 22411-020, Brazil
| | - Tiago Nepomuceno de Miranda
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro, CEP 20230-130, Brazil
| | - Marcelo Henrique Mamede
- Department of Anatomy and Radiology, Full Professor, Medicine School - UFMG, Avenida Presidente Antônio Carlos, 6627 Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
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7
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Conventional Ethiodized Oil Transarterial Chemoembolization for Treatment of Hepatocellular Carcinoma: Contemporary Single-Center Review of Clinical Outcomes. AJR Am J Roentgenol 2016; 206:645-54. [PMID: 26901023 DOI: 10.2214/ajr.15.14758] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Konishi T, Nishihara H, Ito T, Tanaka Y. Infective endocarditis presenting initially with ileus complicated by dehiscence of annuloplasty ring. BMC Cardiovasc Disord 2015; 15:124. [PMID: 26466683 PMCID: PMC4607247 DOI: 10.1186/s12872-015-0113-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 09/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) on an annuloplasty ring dehiscence is uncommon after mitral valve repair. CASE PRESENTATION A 53-year-old man underwent mitral annuloplasty with a 24-mm ring for posterior mitral valve prolapse. He underwent repeat valve repair for recurrent mitral valve regurgitation 4 years later. He was re-hospitalised complaining of vomiting, nausea, general fatigue and left abdominal pain 2 months later, and presented with low-grade fever, leukocytosis and an elevated blood concentration of C-reactive protein. An abdominal computed tomography scan showed multiple embolisms in the liver, kidney and spleen. Transoesophageal echocardiography revealed mitral annuloplasty ring dehiscence and vegetations consistent with IE. The infected annuloplasty ring and vegetations were surgically excised. Blood cultures grew coagulasenegative staphylococcus aureus, consistent with the excised mitral valve histology. The postoperative course was uneventful, without recurrence of IE. CONCLUSIONS Embolic ileus as initial manifestation of IE is rare and might confuse the diagnosis and delay its management. Gastrointestinal signs and symptoms may be the initial manifestations of systemic embolization from infective endocarditis. Transoesophageal echocardiography effectively identified the presence of vegetations and mitral annuloplasty ring dehiscence.
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Affiliation(s)
- Takao Konishi
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622, Japan. .,Department of Translational Pathology, Hokkaido University, Graduate School of Medicine, Sapporo, Japan.
| | - Hiroshi Nishihara
- Department of Translational Pathology, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Tadashi Ito
- Department of Cardiovascular Surgery, Self Defence Forces Central Hospital, Tokyo, Japan
| | - Yoshiaki Tanaka
- Department of Cardiovascular Surgery, Saitama Eastern Cardiovascular Hospital, Saitama, Japan
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Abusedera MA, Arafa UA, Ali EM. Transcatheter administration of buffered Lidocaine for pain relief due to transarterial chemoembolization for HCC. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Wells D, Alisky J, Ray CE. Mental status changes postchemoembolization: the role of inflammatory response. Semin Intervent Radiol 2014; 30:219-22. [PMID: 24436540 DOI: 10.1055/s-0033-1342965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Joseph Alisky
- Departments of Hospitalist Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
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Muros-Ortega M, Díaz-Carrasco MS, Capel A, Calleja MÁ, Martínez F. Effectiveness and safety of doxorubicin loaded beads in hepatocellular carcinoma. Int J Clin Pharm 2013; 35:1105-12. [DOI: 10.1007/s11096-013-9831-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/22/2013] [Indexed: 02/08/2023]
Affiliation(s)
- María Muros-Ortega
- Pharmacy Department, Fresenius Medical Care Services Murcia SL, C/Valle de Ordesa, 45, 30740, San Pedro del Pinatar, Murcia, Spain,
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12
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Petersen J, Henninger B, Glodny B, Jaschke W. [Transarterial chemoembolisation in hepatocellular carcinoma]. Wien Med Wochenschr 2013; 163:123-7. [PMID: 23413009 DOI: 10.1007/s10354-013-0180-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 01/13/2013] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma is one of the most common cause of cancer related death. The present review gives an overview on the loco-regional therapy performed by transarterial chemoembolization (TACE).TACE combines two different therapeutic approaches. First, application of chemotherapeutic agents into tumor's feeding vessels and second, selectively de-arterialization by different particle embolization applicated during angiography. Different chemoembolization agents and techniques are described. The methode is save and less invasive. Side effects range from the postembolization syndrom with nausea, vomiting, fever and abdominal pain up to hepatic insufficiency, which is very rare.The aim of the therapy is control clinical symptoms, prolonge progression free survival, stabilize quality of life and survival. Further indications are bridging therapy prior liver transplantation and TACE is used as a neoadjuvant therapy.Thus, TACE plays a role in the therapy of HCC and indication should be tailored to the individual patient's condition by an interdisciplinary tumor board.
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Affiliation(s)
- Johannes Petersen
- Department Radiologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020 Innsbruck, Österreich.
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Kogut MJ, Chewning RH, Harris WP, Hippe DS, Padia SA. Postembolization syndrome after hepatic transarterial chemoembolization: effect of prophylactic steroids on postprocedure medication requirements. J Vasc Interv Radiol 2013; 24:326-31. [PMID: 23380736 DOI: 10.1016/j.jvir.2012.11.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 11/20/2012] [Accepted: 11/20/2012] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate the impact of prophylactic use of dexamethasone and scopolamine on analgesic and antiemetic agent requirements after transarterial chemoembolization. MATERIALS AND METHODS A total of 148 patients underwent 316 rounds of chemoembolization for hepatocellular carcinoma at a single institution over a 17-month period. Patient charts were retrospectively reviewed for demographic data, procedural technique, and use of analgesic and antiemetic medications. Patients were grouped into three categories: group A received steroid prophylaxis before and after the procedure, group B received steroid prophylaxis before the procedure only, and group C received no steroid prophylaxis. RESULTS Analysis was performed on 125 patients undergoing 252 procedures. Demographics were similar among groups. Overall, 86 (68.8%) were male, and mean age was 62 years (range, 39-82 y). Ninety-one patients (75%) had Child-Pugh class A cirrhosis and 25% had Child-Pugh class B cirrhosis. Dexamethasone was not significantly associated with decreased analgesic agent use (P = .6). Group A patients used significantly fewer antiemetic agents (Δ = 0.89; P = .007) compared with group C. A transdermal scopolamine patch was not associated with reduced use of antiemetic agents (P = .3). Age was inversely associated with analgesic (P <.001) and antiemetic agent use (P = .004). Men received significantly fewer antiemetic agents than women (P = .002), whereas there was no significant difference in analgesic agent use (P = .7). CONCLUSIONS The use of steroids did not affect analgesic agent use and had a minor effect on antiemetic requirements. The use of a scopolamine patch was not associated with reduced antiemetic agent use.
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Affiliation(s)
- Matthew J Kogut
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington 98195, USA.
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Abstract
OBJECTIVE Arterially directed therapies for hepatocellular carcinoma are used for patients who are not candidates for surgery or ablation and for those who need a bridge or down-staging to liver transplantation. These therapies seem to prolong the overall survival when compared with supportive care. CONCLUSION Chemoembolization, particle embolization, drug-eluting beads, and radioembolization have been used for locoregional control. This review discusses patient selection, techniques, safety, clinical outcomes, and imaging findings related to these therapies.
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15
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Martin R, Irurzun J, Munchart J, Trofimov I, Scupchenko A, Tatum C, Narayanan G. Optimal technique and response of doxorubicin beads in hepatocellular cancer: bead size and dose. THE KOREAN JOURNAL OF HEPATOLOGY 2011; 17:51-60. [PMID: 21494078 PMCID: PMC3304625 DOI: 10.3350/kjhep.2011.17.1.51] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND/AIMS It has been shown that the drug-eluting beads loaded with doxorubicin (DEBDOX) are effective for the treatment of hepatocellular carcinoma (HCC). However, the optimal safety and efficacy still remain to be established by using various bead sizes, doxorubicin doses, and the degree of stasis.The aim of this study was to determine the optimal safety and efficacy of DEBDOX in the treatment of HCC. METHODS Analysis of a 503-patient prospective, multicenter, multinational Bead Registry Database from 2007 to 2010 identified 206 patients who had been treated for HCC with DEBDOX. Primary endpoints were to compare safety, tolerance, response rates, and overall survival based on bead size (100-300, 300-500, 500-700, and 700-900 μm), number of vials, doxorubicin dose, and degree of stasis. RESULTS In total, 206 patients underwent 343 treatments. The use of all four bead sizes was similar based on Child-Pugh class and Okuda stage, with a significantly higher use (50%) of beads of size 100-300 μm in patients with portal vein thrombosis (P=0.05). Significant differences were seen for the number of median treatments, median doxorubicin dose, lobar infusion), and degree of complete stasis. The rate of adverse events was higher for larger beads than for smaller beads (28% vs. 16%; P=0.02). CONCLUSIONS Bead size and dose may vary according to disease distribution. Smaller beads offer the opportunity for repeated treatments, a larger cumulative dose delivery, a lesser degree of complete stasis, and fewer adverse events.
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Affiliation(s)
- Robert Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville College of Medicine, Louisville, KY 40202, USA.
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Rode A. [Radiological treatment of hepatocellular carcinoma in 2010]. Cancer Radiother 2011; 15:21-7. [PMID: 21257330 DOI: 10.1016/j.canrad.2010.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Revised: 06/02/2010] [Accepted: 07/23/2010] [Indexed: 11/19/2022]
Abstract
Several radiological techniques have been used for treating hepatocellular carcinoma. These include transcatheter arterial chemoembolization (TACE) and percutaneous therapy, such as radiofrequency (RF). The treatment efficacy of radiofrequency for hepatocellular carcinoma has been confirmed by several randomized and non randomized studies, with a benefit in terms of morbidity comparatively to surgery when cirrhosis is present. Radiofrequency ablation treatment is based on tumour size, shape and location, with a defined strategy and a proper patient selection. We will also review indications and technical aspects of transcatheter arterial chemoembolization (TACE). It is an accepted worldwide and effective treatment for patients with unresectable large or multinodular hepatocellular carcinoma. It improves significantly survival for adequate selected patients with preservation of liver function.
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Affiliation(s)
- A Rode
- Service d'imagerie médicale, hôpital de la Croix-Rousse, 93 grande rue de la Croix-Rousse, Lyon cedex 04, France
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Single-center phase II trial of transarterial chemoembolization with drug-eluting beads for patients with unresectable hepatocellular carcinoma: initial experience in the United States. Cancer J 2011; 15:526-32. [PMID: 20010173 DOI: 10.1097/ppo.0b013e3181c5214b] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE This prospective phase II pilot study evaluated safety and efficacy of transarterial chemoembolization (TACE) with drug-eluting beads (DEBs) loaded with doxorubicin in patients with unresectable hepatocellular carcinoma (HCC). METHODS Twenty patients with unresectable HCC (75% Child's A, 95% Eastern Cooperative Oncology Group performance status 0 to 1, 60% Barcelona Clinic Liver Cancer C, tumor size 6.9 cm) underwent 34 DEB-TACE sessions. Primary endpoints were tumor response, assessed by contrast-enhanced magnetic resonance imaging at 1 month after treatment, using size (response evaluation criteria in solid tumors [RECIST]), contrast-enhancement (European Association for the Study of the Liver) and apparent diffusion coefficient values, and safety assessed by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE). Secondary endpoints included feasibility, progression-free survival, and overall survival. RESULTS DEB-TACE was successfully performed in 34 sessions and demonstrated a favorable safety profile. On initial (1 month) postprocedural magnetic resonance imaging, treated lesions had a mean decrease in size of 4% (P = 0.1129). Using RECIST, partial response was achieved in 2 patients (10%), and 18 patients (90%) had stable disease. Treated tumors demonstrated a mean decrease in contrast enhancement of 64% (P < 0.0001). By European Association for the Study of the Liver criteria, 12 patients (60%) had objective tumor response, and 8 (40%) had stable disease. No patients had progression of a treated lesion while undergoing treatment. At 6 months, the disease control rate was 95% using RECIST. Overall survival rates at 1 and 2 years were 65% and 55%, respectively; median overall survival was 26 months. DISCUSSION DEB-TACE is safe and effective in achieving local tumor control in patients with unresectable HCC.
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Tratamiento percutáneo e intraarterial del carcinoma hepatocelular. RADIOLOGIA 2010; 52:399-413. [DOI: 10.1016/j.rx.2010.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 05/10/2010] [Accepted: 05/14/2010] [Indexed: 01/14/2023]
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Abstract
Treatment of primary and secondary hepatic malignancies with transarterial chemoembolization represents an essential component of interventional oncology. This article discusses patient selection, procedure technique, results, and complications associated with transarterial chemoembolization.
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Review on transarterial chemoembolization in hepatocellular carcinoma: Palliative, combined, neoadjuvant, bridging, and symptomatic indications. Eur J Radiol 2009; 72:505-16. [DOI: 10.1016/j.ejrad.2008.08.007] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 08/07/2008] [Accepted: 08/11/2008] [Indexed: 02/07/2023]
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Ganguli S, Faintuch S, Salazar GM, Rabkin DJ. Postembolization syndrome: changes in white blood cell counts immediately after uterine artery embolization. J Vasc Interv Radiol 2008; 19:443-5. [PMID: 18295706 DOI: 10.1016/j.jvir.2007.11.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Revised: 11/28/2007] [Accepted: 11/28/2007] [Indexed: 10/22/2022] Open
Abstract
Postembolization syndrome (PES) after transcatheter uterine artery embolization (UAE) is classically described as including self-limited pain, nausea, vomiting, and fever. However, the expected components of PES after UAE might also include leukocytosis, the incidence and magnitude of which have not yet been determined. A retrospective review of 78 patients who underwent elective UAE for symptomatic leiomyomas showed an increase in white blood cell (WBC) counts within 24 hours after the procedure in 86% of patients, with clinically defined leukocytosis (WBC count >11,000/microL) present in 21% of patients. Interventional radiologists and other clinicians involved in the care of these patients should expect such changes and not be alarmed regarding early infectious complications.
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Affiliation(s)
- Suvranu Ganguli
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
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Wang ZX, Sun CH, Wang Q. Psychological intervention and pharmacological analgesia during hepatic arterial chemoembolization therapy: an analysis of 216 cases. Shijie Huaren Xiaohua Zazhi 2008; 16:1017-1020. [DOI: 10.11569/wcjd.v16.i9.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the pain relief effect of psychological intervention and pharmacological analgesia during hepatic arterial chemoem-bolization procedure.
METHODS: Two hundred and sixty-two patients underwent hepatic arterial chemoembolization for unresectable hepatic carcinoma were randomized into pharmacological analgesia group (n = 46) and combined therapy group (n = 216, psychological intervention and medication were performed in turn). The baseline characteristics, psychological status and NRS-10 scores before pain control showed no statistical difference between two groups. All patients were measured with Symptom Checklist-90 (SCL-90) before embolization and pain Numeric Rating Scale-10 (NRS-10) score were recorded before psychological intervention/medication, after psychological intervention (only in combined therapy group) and following medication during therapeutic process.
RESULTS: Postembolization pain was significantly relieved after medication, psychological intervention or combined therapy (t' = 4.47, 5.79, 20.24, P < 0.01). There were obvious differences among the curative effect scores (pre-therapy NRS-10 score-post-therapy NRS-10 score) of the above three therapeutic methods (F = 21.98, P < 0.01). According to the curative effect scores, medication and combined therapy were more satisfactory than psychological intervention (2.71 ± 4.05, 3.40 ± 3.82 vs 1.24 ± 2.76; both P < 0.01). Combined therapy was the best method for pain relief, but its curative effect score indicated no statistical difference from that of medication.
CONCLUSION: Pharmacological analgesia combined with psychological intervention is able to relieve pain efficiently during hepatic arterial chemoembolization procedure.
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Wang ZX, Liu SL, Sun CH, Wang Q. Psychological intervention reduces postembolization pain during hepatic arterial chemoembolization therapy: A complementary approach to drug analgesia. World J Gastroenterol 2008; 14:931-5. [PMID: 18240352 PMCID: PMC2687062 DOI: 10.3748/wjg.14.931] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess whether psychological intervention reduces postembolization pain during hepatic arterial chemoembolization therapy.
METHODS: Two hundred and sixty-two patients, who required hepatic arterial chemoembolization for hepatic malignancy and postembolization pain, were randomized into control group (n = 46, receiving medication) and intervention group (n = 216, receiving psychological intervention and medication in turn). The symptom checklist-90 (SCL-90) was used to scale the psychological symptoms of the patients before operation. Pain was scored with a 0 to 10 numeric rating scale (NRS-10) before and after analgesia as well as after psychological intervention (only in intervention group).
RESULTS: All psychological symptomatic scores measured with SCL-90 in the intervention group were higher than the normal range in Chinese (P < 0.05). The somatization, phobia and anxiety symptomatic scores were associated with pain numerical rating score before analgesia (r = 0.141, 0.157 and 0.192, respectively, P < 0.05). Patients in both groups experienced pain relief after medication, psychotherapy or psychotherapy combined with medication during the procedure (P < 0.01). Only some patients in the intervention group reported partial or entire pain relief (29.17% and 2.31%) after psychological intervention. The pain score after analgesia in the intervention group was significantly lower than that in the control group (P < 0.01).
CONCLUSION: Severe psychological distress occurs in patients with hepatic malignancy. Psychological intervention reduces pain scores significantly during hepatic arterial chemoembolization therapy and is thus, highly recommended as a complementary approach to drug analgesia.
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Dutton S, Hirst A, McPherson K, Nicholson T, Maresh M. A UK multicentre retrospective cohort study comparing hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids (HOPEFUL study): main results on medium-term safety and efficacy. BJOG 2007; 114:1340-51. [DOI: 10.1111/j.1471-0528.2007.01526.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Coldwell DM, Sewell PE. The expanding role of interventional radiology in the supportive care of the oncology patient: From diagnosis to therapy. Semin Oncol 2005; 32:169-73. [PMID: 15815962 DOI: 10.1053/j.seminoncol.2004.11.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Interventional radiology (IR) plays an increasing role in the supportive care of the cancer patient from the placement of catheters to treating the offending tumor via image-guided methods. These methods entail the use of both local and regional means, with thermal ablative technology comprising the former and intra-arterial embolization with radioactive particles the latter. Direct placement of the radiofrequency or cryotherapy probes into tumors that are accessible using computed tomography (CT), ultrasound, or magnetic resonance imaging (MRI) guidance provides reliable symptomatic relief of single or multiple tumors in liver, kidney, lung, bone, or soft tissue. Combined with systemic chemotherapy, these techniques increase patient survival. Intra-arterial delivery of radioactive particles to unresectable tumors both provides symptomatic relief and extends survival when combined with current systemic chemotherapy. These new approaches allow IR to provide crucial therapy for cancer patients.
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Affiliation(s)
- Douglas M Coldwell
- Department of Radiology and Radiation Oncology, University of Mississippi Medical Center, Jackson 39216, USA.
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Ryan JM. Misinterpretation of Postembolization Syndrome after Conservative Treatment of Fibroids. J Vasc Interv Radiol 2004; 15:99-100; author reply 100. [PMID: 14709697 DOI: 10.1097/01.rvi.0000106386.63463.37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Leung DA, Goin JE, Sickles C, Raskay BJ, Soulen MC. Determinants of postembolization syndrome after hepatic chemoembolization. J Vasc Interv Radiol 2001; 12:321-6. [PMID: 11287509 DOI: 10.1016/s1051-0443(07)61911-3] [Citation(s) in RCA: 167] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Postembolization syndrome (PES) occurs in the majority of patients undergoing hepatic chemoembolization, and is the major reason for hospitalization after the procedure. The ability to identify which groups of patients are at increased or decreased risk of PES would be useful to better counsel patients, to minimize toxicity, and to plan inpatient versus outpatient therapy. MATERIALS AND METHODS Seventy hepatic chemoembolization procedures were performed in 29 patients using cytotoxic drugs mixed with Ethiodol and polyvinyl alcohol. The following procedural variables were retrospectively assessed and evaluated for association with PES and length of postprocedural hospitalization: gallbladder embolization, lobe embolized, percentage liver volume embolized, percentage embolized volume occupied by tumor, previous embolization of the same territory, and dose of chemoembolic emulsion. Logistic regression was used to quantify the relative effect of each procedural variable. RESULTS Gallbladder embolization and dose administered were associated with an increased risk of PES and an extended hospitalization, with odds ratios of 2.8 and 3.0, and 3.0 and 4.6, respectively. Previous embolization was associated with a decreased risk of both PES and extended hospitalization, with odds ratios of 0.5 and 0.4, respectively. There was a statistical trend toward significance for gallbladder embolization (P = .06), dose administered (P = .07), and previous embolization (P = .14). CONCLUSION Clinically relevant predictors of the severity of PES and length of postprocedural hospitalization may exist. Avoiding embolization of the gallbladder reduces the risk of PES. Re-embolization of previously treated vessels is associated with decreased toxicity and may assist in selecting patients for treatment on an outpatient basis, especially when a reduced dose is required.
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Affiliation(s)
- D A Leung
- Division of Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, USA
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