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Biolato M, Pompili M. Dexamethasone and N-acetylcysteine before transarterial chemoembolization in hepatocellular carcinoma: A Western perspective. World J Gastroenterol 2024; 30:3635-3639. [DOI: 10.3748/wjg.v30.i31.3635] [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] [Received: 05/01/2024] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 08/13/2024] Open
Abstract
Post-embolization syndrome (PES) is the most common complication in patients with hepatocellular carcinoma treated with transarterial chemoembolization. Many strategies have been evaluated to reduce the incidence of PES, but no standard prevention guidelines currently exist. In a single-center, placebo-controlled trial, Simasingha et al evaluated the prophylactic administration of a combination of dexamethasone and N-acetylcysteine and documented a significant reduction in the incidence of PES (from 80% to 6%), of post-procedural liver decompensation (from 14% to 0%), and a shorter hospital stay (4 days vs 6 days), alongside an acceptable safety profile. The results of this study raise several controversial points regarding their applicability in the Western world. In the West, there is a greater and increasing prevalence of metabolic and alcoholic etiologies of liver cirrhosis, so a not negligible number of patients with type II diabetes or hypertension would be excluded from high-dosage dexamethasone prophylaxis. Furthermore, in the West, there is a preferred use of drug-eluting beads loaded with doxorubicin, which are associated with a lower incidence of PES. A study on prophylaxis with dexamethasone and/or N-acetylcysteine in a Western population is hopefully awaited.
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Affiliation(s)
- Marco Biolato
- Department of Medical and Surgical Sciences, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Maurizio Pompili
- Department of Medical and Surgical Sciences, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
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Kim MS, Yoo S. Correlations Among Perceived Symptoms and Interferences, Barriers to Symptom Management, and Comfort Care in Nurses Caring for Chemotherapy and Transarterial Chemoembolization Patients. Cancer Nurs 2024; 47:E245-E254. [PMID: 36867016 DOI: 10.1097/ncc.0000000000001211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Nursing care, encompassing the physical, psychospiritual, sociocultural, and environmental aspects of care, should ensure patients' comfort in both chemotherapy and transarterial chemoembolization (TACE) treatment. OBJECTIVE The aim of this study was to examine the canonical correlations between perceived symptoms and interferences, barriers to symptom management, and comfort care in nurses caring for chemotherapy and TACE patients. METHODS This cross-sectional study surveyed 259 nurses caring for patients undergoing chemotherapy (n = 109) and TACE (n = 150). Fisher exact test, t tests, χ2 tests, Pearson correlations, and canonical correlations were performed. RESULTS In the chemotherapy nurse group, higher perceived symptoms ( R values = 0.74), higher perceived interference ( R values = 0.84), and higher barriers to pain management ( R values = 0.61) were associated with higher physical ( R values = 0.58) and psychological ( R values = 0.88) comfort care. In the TACE nurse group, the higher the perceived symptoms and perceived interference, the lower the perceived barriers to pain management, and lower barriers to nausea/vomiting management were associated with higher physical, psychological, sociocultural, and environmental care. CONCLUSIONS Nurses caring for TACE patients reported lower perceived symptom interference and comfort care, including physical, psychological, and environmental aspects, than those caring for chemotherapy patients. In addition, there was a canonical correlation among perceived symptoms, symptom interferences, barriers to pain management, and comfort care, including physical and psychological care of nurses caring for chemotherapy and TACE patients. IMPLICATION FOR PRACTICE Nurses caring for TACE patients need to provide physical, psychological, and environmental comfort care for their patients. Oncology nurses caring for chemotherapy and TACE patients should coordinate treatment for co-occurring symptom clusters to enhance comfort care.
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Affiliation(s)
- Myoung Soo Kim
- Author Affiliation: Department of Nursing, Pukyong National University, Busan, South Korea
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Zandieh G, Yazdaninia I, Afyouni S, Shaghaghi M, Borhani A, Mohseni A, Shaghaghi S, Liddell R, Kamel IR. Spectrum of Imaging Findings and Complications After Hepatic Transarterial Chemoembolization for Liver Tumors. J Comput Assist Tomogr 2024:00004728-990000000-00305. [PMID: 38595176 DOI: 10.1097/rct.0000000000001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
ABSTRACT This study reviews the spectrum of imaging findings and complications after transarterial chemoembolization (TACE) for the treatment of primary liver tumors (hepatocellular carcinoma, cholangiocarcinoma) and liver metastases. The review encompasses a spectrum of imaging criteria for assessing treatment response, including the modified Response Evaluation Criteria in Solid Tumors guidelines, tumor enhancement, and apparent diffusion coefficient alterations.We discuss the expected posttreatment changes and imaging responses to TACE, describing favorable and poor responses. Moreover, we present cases that demonstrate potential complications post-TACE, including biloma formation, acute cholecystitis, abscesses, duodenal perforation, arterial injury, and nontarget embolization. Each complication is described in detail, considering its causes, risk factors, clinical presentation, and imaging characteristics.To illustrate these findings, a series of clinical cases is presented, featuring diverse imaging modalities including computed tomography, magnetic resonance imaging, and digital subtraction angiography.
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Affiliation(s)
- Ghazal Zandieh
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Iman Yazdaninia
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Shadi Afyouni
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Mohamadreza Shaghaghi
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Ali Borhani
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Alireza Mohseni
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Shiva Shaghaghi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Robert Liddell
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD
| | - Ihab R Kamel
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
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Bai J, Huang M, Zhou J, Song B, Hua J, Ding R. Development of a predictive nomogram for postembolization syndrome after transcatheter arterial chemoembolization of hepatocellular carcinoma. Sci Rep 2024; 14:3303. [PMID: 38332011 PMCID: PMC10853204 DOI: 10.1038/s41598-024-53711-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/04/2024] [Indexed: 02/10/2024] Open
Abstract
Post-embolization syndrome (PES) is a frequent complication after receiving transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC), but only a few studies have focused on the factors influencing PES in those patients. In this study, the impact factors of PES were explored and a nomogram was constructed to predict the occurrence of PES in HCC patients with TACE. This was a retrospective cohort study of HCC patients who underwent TACE obtained from the third affiliated Hospital of Kunming Medical University between January 1, 2020, and September 1, 2022. T‑test and Chi‑square test were used to search for factors influencing PES occurrence, and then the nomogram was further established based on multivariable logistic regression analysis. Validation of the predictive nomogram was also evaluated by calibration curve, concordance index (C-index), and receiver operating characteristic (ROC) curves. The enrolled patients (n = 258) were randomly assigned to the primary cohort (n = 180) and validation cohort (n = 78) in a 7:3 ratio. Among 180 patients in the primary cohort, 106 (58.89%) experienced PES. TACE types (P = 0.015), embolization degree (P = 0.008), and tumor number (P = 0.026) were identified as predictors by the logistic regression analysis and were used to develop the predictive nomogram. The internally validated and externally validated C-indexes were 0.713 and 0.703, respectively. The calibration curves presented good consistency between actual and predictive survival. Types of embolic agents, embolization degree, and tumor number were found to be the predictors of PES after TACE. The nomogram could reliably predict PES in HCC patients with TACE. This predictive model might be considered for clinical practice.
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Affiliation(s)
- Jinfeng Bai
- Minimally Invasive Intervention Department, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - Ming Huang
- Minimally Invasive Intervention Department, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - Jinmei Zhou
- Minimally Invasive Intervention Department, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - Bohan Song
- Minimally Invasive Intervention Department, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - Jianjie Hua
- Minimally Invasive Intervention Department, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - Rong Ding
- Minimally Invasive Intervention Department, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China.
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Yao Y, Huang X, Zhao C, Wang X, Mi G, Liu J. Summary of the evidence of best practices for the prevention and treatment of embolism syndrome after TACE in primary liver cancer. Front Oncol 2024; 13:1274235. [PMID: 38288104 PMCID: PMC10824559 DOI: 10.3389/fonc.2023.1274235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/14/2023] [Indexed: 01/31/2024] Open
Abstract
Objective This study aims to retrieve, evaluate, and summarize domestic and foreign evidence on the prevention and treatment of embolism syndrome following transcatheter arterial chemoembolization (TACE) for primary liver cancer and to provide an evidence-based foundation for clinical practice. Methods Utilizing the "6S" model, we conducted a systematic search of UpToDate, BMJ Best Practice, domestic and foreign guidelines, and related databases on the prevention and treatment of embolism syndrome following TACE for primary liver cancer. This search included clinical decision-making, guidelines, systematic reviews, evidence summaries, randomized controlled trials, and expert consensus. The search time frame extended from January 1, 2013 to May 1, 2023. Evidence was synthesized after an independent review of the included studies by two investigators. Results A total of 11 articles were included in the analysis, comprising one clinical decision-making article, three clinical guidelines, six expert consensus articles, and one randomized controlled trial. We summarized 31 pieces of evidence across three categories: preoperative preparation, intraoperative interventions, and postoperative symptom management. Conclusion This study presents a comprehensive summary of the best available evidence on the prevention and treatment of embolism syndrome following TACE for primary liver cancer. These findings can serve as a valuable reference for clinical practitioners, enabling nurses to deliver individualized care based on the symptoms and specific needs of liver cancer patients. Systematic review registration http://ebn.nursing.fudan.edu.cn, identifier ES20232398.
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Affiliation(s)
- Yanrong Yao
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xi Huang
- School of Nursing, Shanxi University of Chinese Medicine, Xianyang, China
| | - Chengsi Zhao
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - XiaoYan Wang
- Department of Neonatal Intensive Care Unit, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Guangli Mi
- School of Nursing, Ningxia Medical University, Yinchuan, China
| | - Jingli Liu
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yinchuan, China
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Jain S, Blume H, Rodriguez L, Petre E, Moussa A, Zhao K, Sotirchos V, Raj N, Reidy D, Ziv E, Alexander E. Hepatic Hilar Block as an Adjunct to Transarterial Embolization of Neuroendocrine Tumors: A Retrospective Review of Safety and Efficacy. Cancers (Basel) 2023; 15:5202. [PMID: 37958376 PMCID: PMC10647661 DOI: 10.3390/cancers15215202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/09/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
PURPOSE This study investigates whether hepatic hilar nerve blocks (HHNB) provide safe, effective analgesia in patients with neuroendocrine tumors (NET) treated with transarterial embolization (TAE). METHODS The retrospective study included all NETs treated with TAE or TAE + HHNB from 1/2020 to 8/2022. Eighty-five patients (45 men), mean age 62 years, were treated in 165 sessions (TAE, n = 153; TAE + HHNB, n = 12). For HHNBs, ≤10 mL bupivacaine HCl 0.25% ± 2 mg methylprednisolone were injected under ultrasound guidance. The aims were to assess safety of HHNB and reduction in pain. Groups were compared with Pearson's chi-squared and Wilcoxon rank sum tests. Logistic regression assessed independent risk factors for pain. RESULTS No immediate complications from HHNBs were reported. No difference in incidence of major complications between TAE and TAE + HHNB one month post-embolization was observed (7.19% vs. 8.33%, p = 0.895). No differences in mean length of hospital stay after treatment were observed (TAE 2.2 days [95%CI: 1.74-2.56] vs. TAE + HHNB 2.8 days [95%CI: 1.43-4.26]; p = 0.174). Post-procedure pain was reported in 88.2% of TAE and 75.0% of TAE + HHNB patients (p = 0.185). HHNB recipients were more likely to use analgesic patches (25.0% vs. 5.88%; p = 0.014). No other differences in analgesic use were observed. CONCLUSIONS HHNBs can safely be performed in patients with NETs. No difference in hospital stays or analgesic drug use was observed. Managing pain after TAE is an important goal; further study is warranted.
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Affiliation(s)
- Samagra Jain
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
- Baylor College of Medicine, School of Medicine, One Baylor Plaza, Houston, TX 77004, USA
| | - Harrison Blume
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
- Albert Einstein College of Medicine, School of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, USA
| | - Lee Rodriguez
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
| | - Elena Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
| | - Amgad Moussa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
| | - Ken Zhao
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
| | - Vlasios Sotirchos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
| | - Nitya Raj
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (N.R.); (D.R.)
| | - Diane Reidy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (N.R.); (D.R.)
| | - Etay Ziv
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
| | - Erica Alexander
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
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Roehlen N, Stoehr F, Müller L, Luxenburger H, Gairing SJ, Reincke M, Schultheiss M, Berisha F, Weinmann A, Foerster F, Marquardt JU, Thimme R, Galle PR, Bettinger D, Kloeckner R. Prediction of postembolization syndrome after transarterial chemoembolization of hepatocellular carcinoma and its impact on prognosis. Hepatol Commun 2023; 7:e0252. [PMID: 37756031 PMCID: PMC10531352 DOI: 10.1097/hc9.0000000000000252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/15/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Postembolization syndrome (PES) represents the most frequent complication after transarterial chemoembolization (TACE) in patients with HCC. Given the vague definition as a symptom complex comprising abdominal pain, fever, and nausea, PES is diagnosed in heterogeneous patient cohorts with symptoms ranging from mild pain to severe deterioration of their general condition. This study aimed to evaluate predictive factors and the prognostic impact of PES with regard to different severity grades. METHODS A total of 954 patients treated with TACE for HCC at the University Medical Centres Mainz and Freiburg were included in this study. PES disease severity was graded as mild, moderate, or severe according to a predefined combination of symptoms. Logistic regression models were used to identify independent predictors of PES. The prognostic impact of PES was evaluated by competing risk analyses considering liver transplantation as a competing risk. RESULTS PES occurred in 616 patients (64.5%), but only 56 patients (5.9%) had severe PES, defined as moderate to severe abdominal pain requiring opioids in combination with fever and nausea. The largest tumor diameter was the strongest independent predictor of PES (OR = 1.21, 95% CI = 1.13-1.28), and severe PES (OR = 1.23, 95% CI = 1.14-1.33, p < 0.0001). Presence of liver cirrhosis was protective against PES (OR = 0.48, 95% CI = 0.27-0.84, p = 0.01). Furthermore, PES was independently associated with an impaired disease control rate (OR = 0.33, 95% CI = 0.16-0.69, p = 0.003) and severe PES with poor overall survival (subdistribution HR = 1.53, 95% CI = 0.99-2.36, p = 0.04). CONCLUSIONS Tumor size and absence of liver cirrhosis are predictors of severe PES and associated with impaired prognosis in HCC patients after TACE.
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Affiliation(s)
- Natascha Roehlen
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Stoehr
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Hendrik Luxenburger
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon J. Gairing
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Marlene Reincke
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Schultheiss
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Floriona Berisha
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Arndt Weinmann
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Friedrich Foerster
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jens U. Marquardt
- Department of Medicine I, University Center Schleswig-Holstein-Campus Lübeck, Lübeck, Germany
| | - Robert Thimme
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter R. Galle
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Dominik Bettinger
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
- Department of Diagnostic and Interventional Radiology, University of Lübeck, Lübeck, Germany
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Du QQ, Liang M, Jiang B, Zhang M, Yu XL, Li X, Hao JH. Incidence and predictors of abdominal pain after transarterial chemoembolization of hepatocellular carcinoma: a single-center retrospective study. Eur J Oncol Nurs 2023; 66:102355. [PMID: 37524027 DOI: 10.1016/j.ejon.2023.102355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE To assess the incidence and predictive factors of abdominal pain following transarterial hepatic chemoembolization (TACE) in patients with hepatocellular carcinoma. METHODS In this single-center retrospective cohort study, abdominal pain was defined as a score of 4 or more within 72 h after TACE and requiring additional drug intervention. Patient, tumor characteristics, and technical factors associated with severe pain were identified using the decision tree and binary logistic regression model. RESULTS Of 220 patients who were included in the study, 126 (57.3%) had abdominal pain after 206 of 420 TACE procedures (49.0%). A predictive model built based on the logistic regression identified the drug-eluting bead TACE (DEB-TACE) (odds ratio [OR] = 3.340; 95% confidence interval [CI] 2.169-5.141), the number of tumors (OR = 2.235; 95% CI 1.060-4.713), embolization of both hepatic lobes (OR = 2.310; 95% CI 1.109-4.813), and concomitant extrahepatic artery embolism (OR = 2.654; 95% CI 1.227-5.739) as the independent predictors of severe abdominal pain. Similarly, the decision tree confirmed the DEB-TACE as the strongest predictor of subsequent performance, followed by the history of hepatectomy and the embolization in the right or both lobes. The area under the receiver operating characteristic curve (AUC) of the classification prediction effect of the two models was 0.706 for the logistic regression and 0.676 for the decision tree. Internal validation results show that the accuracy of logistic regression model prediction was 71.4%. CONCLUSION The model suggests that DEB-TACE and multiple treatment sites are predictors of abdominal pain after TACE in patients with hepatocellular carcinoma. It may help improve nursing management practices.
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Affiliation(s)
- Qian-Qian Du
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China; Department of Interventional Therapy, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Min Liang
- Department of Interventional Therapy, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Bo Jiang
- Department of Interventional Therapy, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Miao Zhang
- Nursing Department, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Xiao-Ling Yu
- Nursing Department, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Xiao Li
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Jia-Hu Hao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.
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Gorji L, Aoun H, Critchfield J, Al Hallak N, Beal EW. Locoregional Therapy for Intrahepatic Cholangiocarcinoma: The Role of Intra-Arterial Therapies. Cancers (Basel) 2023; 15:4727. [PMID: 37835420 PMCID: PMC10571998 DOI: 10.3390/cancers15194727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Intrahepatic cholangiocarcinoma (ICC) is a rare disease with a rising incidence. While surgical resection is the only curative option, the disease process is often identified in advanced stages, as this malignancy often remains clinically silent in early development. Only one-third of patients are eligible for resection at the time of diagnosis. For patients who cannot undergo resection, intra-arterial therapies are reasonable palliative treatment options; in rare occasions, these may be bridging therapies, as well. The premise of bland embolization and most chemoembolization intra-arterial therapies is that the arterial supply of the tumor is occluded to induce tumor necrosis, while radioembolization utilizes the arterial flow of the tumor to deliver radiation therapy. In this review, we discuss the use of transarterial embolization, transarterial chemoembolization, and selective internal radiation therapy for the treatment of ICC. Phase III randomized controlled clinical trials are difficult to tailor to this extremely rare and aggressive disease, but ultimately, further investigation should be pursued to define the patient population that will derive the greatest benefit from each modality.
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Affiliation(s)
- Leva Gorji
- Department of Surgery, Kettering Health, Dayton, OH 45402, USA;
| | - Hussein Aoun
- Department of Interventional Radiology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA; (H.A.); (J.C.)
| | - Jeffrey Critchfield
- Department of Interventional Radiology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA; (H.A.); (J.C.)
| | - Najeeb Al Hallak
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA;
| | - Eliza W. Beal
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA;
- Department of Surgery, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA
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10
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Thanakunchai T, Hongthanakorn C. Prevalence and Risk Factors of Post-chemoembolization Syndrome After Chemo-Embolization for Hepatocellular Carcinoma in Thailand. Dig Dis Sci 2023; 68:3818-3823. [PMID: 37402085 DOI: 10.1007/s10620-023-08010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND The data regarding the incidence of post-embolization syndrome after transarterial chemoembolization for hepatocellular carcinoma in Thailand are scarce. Therefore, this study aimed to determine the prevalence and predictors of post-embolization syndrome after transarterial chemoembolization for hepatocellular carcinoma in Thailand. METHODS This retrospective study collected data from patients undergoing transarterial chemoembolization for five years. Post-embolization syndrome was defined as fever and/or abdominal pain, and/or nausea or vomiting that occurred within three days after the transarterial chemoembolization procedure for hepatocellular carcinoma or hospital discharge. Pre-defined predictors for post-embolization syndrome were explored using Poisson regression analysis. RESULTS Of the 298 patients and 739 transarterial chemoembolization procedures, the incidence of post-embolization syndrome was 68.1% (203/298) and the incidence density was 53.9% (398/739). Tumor size, Barcelona Clinic Liver Cancer stages, and dose of chemotherapy showed no association with the occurrence of PES. However, a model for end-stage liver disease score was the only predictor for post-embolization syndrome [adjusted IRR 0.91 (0.84-0.98); p = 0.01]. There were three patients developing fever after transarterial chemoembolization due to infection. CONCLUSION Post-embolization syndrome was common in patients undergoing transarterial chemoembolization for hepatocellular carcinoma. Patients with a lower model for end-stage liver disease scores were at increased risk of post-embolization syndrome. This study highlights the burden of post-embolization syndrome among patients with hepatocellular carcinoma receiving transarterial chemoembolization.
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Affiliation(s)
- Thanabadee Thanakunchai
- Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand
| | - Chanunta Hongthanakorn
- Gastroenterology Unit, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand.
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11
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Okuma Y, Meguro T, Shimoda K, Miyara S, Hirotsune N. Postcoiling syndrome including headache and fever after endovascular cerebral aneurysmal coil embolization: A narrative review. Brain Circ 2023; 9:64-67. [PMID: 37576581 PMCID: PMC10419732 DOI: 10.4103/bc.bc_72_22] [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: 10/04/2022] [Revised: 02/04/2023] [Accepted: 02/24/2023] [Indexed: 08/15/2023] Open
Abstract
Endovascular cerebral aneurysmal coil embolization is becoming more popular than direct aneurysmal neck clipping due to its noninferiority in long-term outcomes and being less invasive. Neuroradiologists often find postoperative symptoms such as headache and fever after unruptured aneurysmal coil embolization, however, they have not paid much attention because symptoms almost always resolve spontaneously within a few days. Since the concept of this syndrome has not been standardized, we named it postcoiling syndrome (PCS). In this short review, we reviewed the criteria, risk factors, mechanisms, significance, and treatment of PCS based on a few pieces of literature. Almost all literature has regarded that some kind of bioactive reaction might be involved in PCS. Preliminary data showed the possibility of inhibition of PCS by histamine-2 receptor antagonists. PCS also might have the potential of more predictive maker than previously reported risk factors for recurrence after aneurysm coil embolization. Further investigation is needed in the future, including the accumulation of cases, unification of concepts, and mid-to-long-term follow-up.
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Affiliation(s)
- Yu Okuma
- Department of Neurological Surgery, Sonoda Daiichi Hospital, Tokyo, Japan
| | - Toshinari Meguro
- Department of Neurological Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kentaro Shimoda
- Department of Neurological Surgery, Sonoda Daiichi Hospital, Tokyo, Japan
| | - Santiago Miyara
- Department of Neurological Surgery, Feinstein Institute for Medical Research, Northwell Health System, Manhasset, NY, USA
| | - Nobuyuki Hirotsune
- Department of Neurological Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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12
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Kumar V, Shah M, Gala D, Singh MK, Jeanty H, Thomas R, Forlemu AN, Gayam VR, Etienne D. Hepatic Dystrophic Calcification Secondary to Transarterial Chemoembolization: Case Report and Review of Literature. Cureus 2023; 15:e35765. [PMID: 37020485 PMCID: PMC10070055 DOI: 10.7759/cureus.35765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 03/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a common malignancy usually treated with surgery. Patients who are not suitable for surgery undergo transarterial chemoembolization (TACE) which involves injecting anti-cancer drugs and embolizing agents into the hepatic artery. Although it is a relatively safe procedure with minor side effects, TACE can rarely cause dystrophic calcification in the liver. We report a case of a 58-year-old female who presented with right-sided chest pain. The patient had been previously treated for HCC with a TACE procedure. A chest x-ray revealed hepatic calcification which was likely secondary to the prior TACE. This case study emphasizes the significance of considering TACE as a potential cause of hepatic dystrophic calcification.
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13
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Mosconi C, O'Rourke J, Kloeckner R, Sturm L, Golfieri R, Celsa C, Fateen W, Odisio BC, Garanzini EM, Peck-Radosavljevic M, Borghi A, Ma YT, Stoehr F, Bettinger D, Giuffrida P, Aithal GP, Lin YM, Spreafico C, Giampalma E, Johnson P, Cucchetti A. Textbook Outcome After Trans-arterial Chemoembolization for Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2023; 46:449-459. [PMID: 36849836 DOI: 10.1007/s00270-023-03375-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/27/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Textbook Outcome (TO) is inclusive of quality indicators and it not been provided for trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS Data on treatment-naïve HCC patients receiving TACE from 10 centers were reviewed. TO was defined as "no post-TACE grade 3-4 complications, no prolonged hospital stay (defined as a post-procedure stay ≤ 75th percentile of the median values from the total cohort), no 30-day mortality/readmission and the achievement of an objective response (OR) at post-TACE imaging." Grade of adverse event was classified according to the Common Terminology Criteria for Adverse Events and short-term efficacy was assessed by response. Pooled estimates were calculated to account for hospital's effect and risk-adjustment was applied to allow for diversity of patients in each center. RESULTS A total of 1124 patients (2014-2018) fulfilling specific inclusion criteria were included. Baseline clinical features showed considerable heterogeneity (I2 > 0.75) across centers. TACE-related mortality was absent in 97.6%, readmission was not required after 94.9% of procedures, 91.5% of patients had no complication graded 3-4, 71.8% of patients did not require prolonged hospitalization, OR of the target lesion was achieved in 68.5%. Risk-adjustment showed that all indicators were achieved in 43.1% of patients, and this figure was similar across centers. The median overall survival for patients who achieved all indicators was 33.1 months, 11.9 months longer than for patients who did not. CONCLUSIONS A useful benchmark for TACE in HCC patients has been developed, which provides an indication of survival and allows for a comparison of treatment quality across different hospitals.
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Affiliation(s)
- Cristina Mosconi
- Department of Diagnostic Medicine and Prevention, Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy.
| | - Joanne O'Rourke
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, Medical School, University of Birmingham, Birmingham, UK
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lukas Sturm
- Department of Medicine II, Faculty of Medicine, Medical Center University of Freiburg, University of Freiburg, Hugstetter Street 55, 79106, Freiburg, Germany.,Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rita Golfieri
- Department of Diagnostic Medicine and Prevention, Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy
| | - Ciro Celsa
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Marina, Italy
| | - Waleed Fateen
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, The University of Nottingham, Nottingham, UK
| | - Bruno C Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Markus Peck-Radosavljevic
- Department of Internal Medicine and Gastroenterology, Klinikum Klagenfurt Am Wörthersee, Klagenfurt, Austria
| | - Alberto Borghi
- Department of Internal Medicine, Infermi Hospital, Area Vasta Romagna, Faenza, Italy
| | - Yuk Ting Ma
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, Medical School, University of Birmingham, Birmingham, UK
| | - Fabian Stoehr
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Dominik Bettinger
- Department of Medicine II, Faculty of Medicine, Medical Center University of Freiburg, University of Freiburg, Hugstetter Street 55, 79106, Freiburg, Germany.,Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Paolo Giuffrida
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Marina, Italy
| | - Guruprasad P Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, The University of Nottingham, Nottingham, UK
| | - Yuan-Mao Lin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlo Spreafico
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | | | - Philip Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Morgagni-Pierantoni Hospital, Area Vasta Romagna, Forlì, Italy
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14
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Kim MS, Kang M, Park J, Ryu JM. Nurses' comfort care of transarterial chemoembolization patients based on their perceptions around postembolization syndrome and symptom interference. Nurs Open 2022; 10:2877-2885. [PMID: 36565057 PMCID: PMC10077417 DOI: 10.1002/nop2.1529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 10/03/2022] [Accepted: 11/20/2022] [Indexed: 12/25/2022] Open
Abstract
AIM Post-embolization syndrome is a common adverse event following trans-arterial chemoembolization, which negatively impacts the daily life of the patients involved. This study examined whether perceptions around post-embolization syndrome and symptom interference among nurses affect their comfort care performance toward patients who have undergone this procedure. DESIGN A descriptive cross-sectional study. METHODS One hundred and fifty registered nurses were surveyed from September to November 2020. Perceived post-embolization syndrome, symptom interference, and comfort care (including physical, psychospiritual, sociocultural, and environmental dimensions) were measured. Data were analyzed using t-tests, analysis of variance, Pearson's correlation, and a multivariate analysis of variance. RESULTS There were no individual effects found of perceived post-embolization syndrome or symptom interference on nurses' comfort care performance. However, statistically significant interaction effects were found in terms of their sociocultural and environmental care. CONCLUSION Nurses who recognized both high post-embolization syndrome and symptom interference among their patients were found to provide greater sociocultural and environmental care. As such, nurses should improve their early symptom and symptom interference detection protocols based on current care guidelines and provide physical, psychospiritual, sociocultural, and environmental comfort care.
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Affiliation(s)
- Myoung Soo Kim
- Department of Nursing, Pukyong National University, Busan, South Korea
| | - Minkyeong Kang
- Department of Nursing, Pukyong National University, Busan, South Korea
| | - Jiwon Park
- Department of Nursing, Pukyong National University, Busan, South Korea
| | - Jung Mi Ryu
- Department of Nursing, Busan Institute of Science and Technology, Busan, South Korea
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15
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Bell R, Begum S, Prasad R, Taura K, Dasari BVM. Volume and flow modulation strategies to mitigate post-hepatectomy liver failure. Front Oncol 2022; 12:1021018. [PMID: 36465356 PMCID: PMC9714434 DOI: 10.3389/fonc.2022.1021018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/20/2022] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Post hepatectomy liver failure is the most common cause of death following major hepatic resections with a perioperative mortality rate between 40% to 60%. Various strategies have been devised to increase the volume and function of future liver remnant (FLR). This study aims to review the strategies used for volume and flow modulation to reduce the incidence of post hepatectomy liver failure. METHOD An electronic search was performed of the MEDLINE, EMBASE and PubMed databases from 2000 to 2022 using the following search strategy "Post hepatectomy liver failure", "flow modulation", "small for size flow syndrome", "portal vein embolization", "dual vein embolization", "ALPPS" and "staged hepatectomy" to identify all articles published relating to this topic. RESULTS Volume and flow modulation strategies have evolved over time to maximize the volume and function of FLR to mitigate the risk of PHLF. Portal vein with or without hepatic vein embolization/ligation, ALPPS, and staged hepatectomy have resulted in significant hypertrophy and kinetic growth of FLR. Similarly, techniques including portal flow diversion, splenic artery ligation, splenectomy and pharmacological agents like somatostatin and terlipressin are employed to reduce the risk of small for size flow syndrome SFSF syndrome by decreasing portal venous flow and increasing hepatic artery flow at the same time. CONCLUSION The current review outlines the various strategies of volume and flow modulation that can be used in isolation or combination in the management of patients at risk of PHLF.
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Affiliation(s)
- Richard Bell
- Department of Hepatobiliary and Transplant Surgery, St. James’s University Hospital, Leeds, United Kingdom
| | - Saleema Begum
- Department of Hepatobiliary and Pancreatic (HPB) and Transplant Surgery, University Hospital Birmingham, Birmingham, United Kingdom
| | - Raj Prasad
- Department of Hepatobiliary and Transplant Surgery, St. James’s University Hospital, Leeds, United Kingdom
| | - Kojiro Taura
- Division of Hepatobiliary and Pancreatic (HPB) Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Bobby V. M. Dasari
- Department of Hepatobiliary and Pancreatic (HPB) and Transplant Surgery, University Hospital Birmingham, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
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16
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Gibson EA, Goldman RE, Culp WTN. Comparative Oncology: Management of Hepatic Neoplasia in Humans and Dogs. Vet Sci 2022; 9:vetsci9090489. [PMID: 36136704 PMCID: PMC9505178 DOI: 10.3390/vetsci9090489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
Primary hepatic neoplasia is uncommonly reported in dogs. Hepatocellular carcinoma (HCC) is the most frequent neoplasia identified in dogs and considerable effort has been committed towards identifying definitive and palliative treatment options. HCC is well recognized in humans as a sequelae of liver disease such as hepatitis or cirrhosis, while in dogs a similar link has failed to be fully elucidated. Management of HCC in people may be curative or palliative dependent on staging and transplant eligibility. Despite differences in etiology, there is substantial similarity between treatment options for liver neoplasia in human and veterinary medicine. The below summary provides a comparative discussion regarding hepatic neoplasia in dogs and people with a specific focus on HCC. Diagnosis as well as descriptions of the myriad treatment options will be reviewed.
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Affiliation(s)
- Erin A. Gibson
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
| | - Roger E. Goldman
- Department of Radiology, University of California-Davis Medical Center, Sacramento, CA 95817, USA
| | - William T. N. Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
- Correspondence:
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17
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Kim MS, Uhm JY. Impact of discriminant factors on the comfort-care of nurses caring for trans-arterial chemoembolisation patients. Support Care Cancer 2022; 30:7773-7781. [PMID: 35710640 DOI: 10.1007/s00520-022-07221-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/13/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was conducted to identify the levels of comfort-care provided by trans-arterial chemoembolisation (TACE) nurses and examine the discriminant factors thereof. METHODS Nurses (n = 146) with experience in caring for TACE patients, participated in this study. The data were collected using an online self-rated questionnaire and analysed with descriptive statistics and discriminant analysis. The discriminating factors included perception of post-embolisation syndrome and symptom interference, caring attitude, barriers to pain and nausea/vomiting management, and supportive care competence. RESULTS The participants were classified into three groups, depending on the level of their comfort-care: "low" (n = 27), "moderate" (n = 88), and "high" (n = 31) comfort-care groups. One function significantly discriminated between the low and high comfort-care groups and correctly classified 79.3% of the participants in the cross-validation run. Supportive care competence (0.864), caring attitude (0.685), perception of symptom interference (0.395), perception of post-embolisation syndrome (0.321), and barriers to nausea/vomiting management (- 0.343) were significant discriminant factors of comfort-care. CONCLUSION A low proportion of the participants provided high levels of comfort-care, which was determined by five discriminant factors. The study's findings imply that the development of supportive care competence, authentic human caring attitude, early detection of patients' symptoms and symptom interference, and the development of manuals and guidelines for removing barriers for nausea and vomiting are needed to improve the comfort-care of nurses caring for TACE patients.
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Affiliation(s)
- Myoung Soo Kim
- Department of Nursing, Pukyong National University, Yongso-ro 45, Busan, 48513, Korea
| | - Ju-Yeon Uhm
- Department of Nursing, Pukyong National University, Yongso-ro 45, Busan, 48513, Korea.
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18
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Samuel N, Weisse C, Berent AC, Rogatko CP, Wittenburg L, Lamb K. Pharmacokinetic study comparing doxorubicin concentrations after chemoembolization or intravenous administration in dogs with naturally occurring nonresectable hepatic carcinoma. J Vet Intern Med 2022; 36:1792-1799. [PMID: 35971921 PMCID: PMC9511073 DOI: 10.1111/jvim.16520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background Chemoembolization is a viable treatment option for patients with nonresectable hepatic carcinoma (HC) and may allow delivery of chemotherapeutic drugs with decreased systemic toxicity. Hypothesis/Objective Compare the serum concentrations of doxorubicin after chemoembolization or IV administration in the same patient. We hypothesized that locoregional delivery may result in increased tumor chemotherapeutic drug concentrations, reflected by decreased measurable serum drug concentrations. Adverse hematological events were hypothesized to be decreased after locoregional delivery. Animals Seventeen client‐owned dogs with incompletely resectable HC. Methods Prospective, single‐arm clinical trial. Drug‐eluting bead transarterial chemoembolization was performed to varying levels of blood flow stasis (NO STASIS, STASIS). Intravenous doxorubicin (IVC) subsequently was administered in selected patients. Systemic exposure was quantified by area under the serum doxorubicin concentration time curve (AUC), maximum serum doxorubicin concentration (Cmax), and time doxorubicin was last above the limit of quantitation (Tlast). Nadir test results after treatments were used to evaluate adverse hematological events. Results Thirteen NO STASIS treatments, 15 STASIS treatments, and 9 IVC treatments were performed. Maximum serum doxorubicin concentration, AUC, and Tlast were significantly lower when comparing NO STASIS or STASIS to IVC treatments. Of the patients with nadir results available, no adverse hematological events were observed after NO STASIS or STASIS treatments. Two patients developed adverse hematological events after IVC treatment. Conclusions/Clinical Relevance Drug‐eluting bead transarterial chemoembolization offers a viable treatment option for patients with incompletely resectable HC with the potential for increased local tumor doxorubicin concentrations, decreased systemic chemotherapeutic exposure, and fewer adverse hematological events.
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Affiliation(s)
- Nina Samuel
- The Schwarzman Animal Medical Center, New York City, New York, USA.,University of California Davis Veterinary Medical Teaching Hospital, Davis, California, USA
| | - Chick Weisse
- The Schwarzman Animal Medical Center, New York City, New York, USA
| | - Allyson C Berent
- The Schwarzman Animal Medical Center, New York City, New York, USA
| | - Cléo P Rogatko
- The Schwarzman Animal Medical Center, New York City, New York, USA.,Veterinary Surgical Centers, Vienna, Virginia, USA
| | - Luke Wittenburg
- University of California Davis Veterinary Medical Teaching Hospital, Davis, California, USA
| | - Kenneth Lamb
- Lamb Statistical Consulting LLC, West Saint Paul, Minnesota, USA
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19
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Kotsifa E, Vergadis C, Vailas M, Machairas N, Kykalos S, Damaskos C, Garmpis N, Lianos GD, Schizas D. Transarterial Chemoembolization for Hepatocellular Carcinoma: Why, When, How? J Pers Med 2022; 12:jpm12030436. [PMID: 35330436 PMCID: PMC8955120 DOI: 10.3390/jpm12030436] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. It is principally associated with liver cirrhosis and chronic liver disease. The major risk factors for the development of HCC include viral infections (HBV, HCV), alcoholic liver disease (ALD,) and non-alcoholic fatty liver disease (NAFLD). The optimal treatment choice is dictated by multiple variables such as tumor burden, liver function, and patient’s health status. Surgical resection, transplantation, ablation, transarterial chemoembolization (TACE), and systemic therapy are potentially useful treatment strategies. TACE is considered the first-line treatment for patients with intermediate stage HCC. The purpose of this review was to assess the indications, the optimal treatment schedule, the technical factors associated with TACE, and the overall application of TACE as a personalized treatment for HCC.
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Affiliation(s)
- Evgenia Kotsifa
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, AgiouThoma 17, 11527 Athens, Greece; (N.M.); (S.K.); (C.D.); (N.G.)
- Correspondence:
| | - Chrysovalantis Vergadis
- Department of Radiology, General Hospital of Athens “Laiko”, AgiouThoma 17, 11527 Athens, Greece;
| | - Michael Vailas
- First Department of Surgery, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, AgiouThoma 17, 11527 Athens, Greece; (M.V.); (D.S.)
| | - Nikolaos Machairas
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, AgiouThoma 17, 11527 Athens, Greece; (N.M.); (S.K.); (C.D.); (N.G.)
| | - Stylianos Kykalos
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, AgiouThoma 17, 11527 Athens, Greece; (N.M.); (S.K.); (C.D.); (N.G.)
| | - Christos Damaskos
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, AgiouThoma 17, 11527 Athens, Greece; (N.M.); (S.K.); (C.D.); (N.G.)
| | - Nikolaos Garmpis
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, AgiouThoma 17, 11527 Athens, Greece; (N.M.); (S.K.); (C.D.); (N.G.)
| | - Georgios D. Lianos
- Department of Surgery, University Hospital of Ioannina, 45110 Ioannina, Greece;
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, AgiouThoma 17, 11527 Athens, Greece; (M.V.); (D.S.)
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20
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Association of Cirrhosis and Other Patient and Procedural Characteristics With Postembolization Syndrome after Bland Hepatic Artery Embolization for Hepatic Malignancy. AJR Am J Roentgenol 2022; 218:1030-1039. [DOI: 10.2214/ajr.21.26806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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21
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She Y, Huang Q, Ye Z, Hu Y, Wu M, Qin K, Wei A, Yang X, Liu Y, Zhang C, Ye Q. The Therapeutic Principle of Combined Strengthening Qi and Eliminating Pathogens in Treating Middle-Advanced Primary Liver Cancer: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:714287. [PMID: 34776950 PMCID: PMC8578139 DOI: 10.3389/fphar.2021.714287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/27/2021] [Indexed: 12/25/2022] Open
Abstract
Background: The combination of strengthening Qi and eliminating pathogens is an available therapeutic principle in traditional Chinese medicine (TCM) for primary liver cancer (PLC) at middle-advanced stage. However, there is a lack of reasonable evidence to support the proper application of this therapeutic principle. This meta-analysis aims to evaluate the efficacy and safety of Chinese medicinal formulas (CMFs), including two subgroup analyses of the principle of strengthening Qi and eliminating pathogens. Method: Clinical trials were obtained through searching of EMBASE, Web of Science, PubMed, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, and two clinical trial registries. The randomized controlled trials with the combination of CMFs and transcatheter arterial chemoembolization (TACE) in the experiment group were acceptable, in contrast to the TACE alone in the control group. The statistics analysis was performed on Review Manager 5.4. Results: A total of eligible 24 trials were accessed in this work. Overall, CMFs could improve the survival duration of 6 months, 1 year, and 2 years, Karnofsky Performance Status, tumor objective response rate (ORR), AFP, and symptom. In the subgroup analysis, trials complying with the principle of single strengthening Qi did not show any significant difference in increasing tumor ORR. Meanwhile, the principle of combined strengthening Qi and eliminating pathogens was uncertain in improving symptoms and 1-year and 2-year survival time. In addition, the outcome indexes of ALT and AST were heterogeneous. In last, the total occurrence of adverse events could not be reduced via using CMFs. Patients treated with CMFs exhibited liver injury, fever, and white blood cell decline, with mild events occurring more frequently and severe events occurring less. Conclusion: CMFs are an effective treatment method to cure PLC at the middle-advanced stage. Adopting the principle of single strengthening Qi presents better efficacy in the long term by prolonging the survival duration. Following the principle of combined strengthening Qi and eliminating pathogens could be more beneficial to patients in short term by lessening the tumor size. CMFs have the advantage of reducing certain serious adverse events.
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Affiliation(s)
- Yingqi She
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qinfeng Huang
- Department of Oncology, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Zhen Ye
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu Hu
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mingquan Wu
- Department of Pharmacy, Sichuan Provincial Orthopedic Hospital, Chengdu, China
| | - Kaihua Qin
- Health Preservation and Rehabilitation College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ailing Wei
- Department of Liver Disease, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Xin Yang
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuyao Liu
- Pharmacy College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Cuihan Zhang
- Pharmacy College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiaobo Ye
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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22
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Kashfi S, Murdakhayev E, Rehmani R, Sharma S. Post-Embolization Syndrome Complicated by Hypertensive Emergency and Severely Elevated Transaminases. Cureus 2021; 13:e15446. [PMID: 34258113 PMCID: PMC8255082 DOI: 10.7759/cureus.15446] [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] [Accepted: 06/04/2021] [Indexed: 11/05/2022] Open
Abstract
Transarterial chemoembolization (TACE) is a procedure reserved for the treatment of hepatocellular cancer that is unresectable through surgery. It combines both embolization and chemotherapy by injecting chemotherapy via a catheter directed at the tumor and then blocking the artery to prevent blood flow to the tumor. We present the case of a 69-year-old man who experienced post-embolization syndrome (PES) with a hypertensive emergency and elevated liver transaminases following his TACE procedure. Imaging combined with clinical assessment was necessary to determine whether the patient was experiencing a ruptured hepatic abscess or PES, as both are potential complications of TACE. The patient was ultimately managed with supportive care and discharged after several days.
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Affiliation(s)
- Simon Kashfi
- Internal Medicine, City University of New York (CUNY) School of Medicine, New York, USA
| | - Elizabeth Murdakhayev
- Internal Medicine, City University of New York (CUNY) School of Medicine, New York, USA
| | - Razia Rehmani
- Radiology, St. Barnabas Hospital Health System, Bronx, USA
| | - Shorabh Sharma
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
- Internal Medicine, Hospitalist, Bronx, USA
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23
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Rogatko CP, Weisse C, Schwarz T, Berent AC, Diniz MA. Drug-eluting bead chemoembolization for the treatment of nonresectable hepatic carcinoma in dogs: A prospective clinical trial. J Vet Intern Med 2021; 35:1487-1495. [PMID: 33955600 PMCID: PMC8162590 DOI: 10.1111/jvim.16109] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 12/14/2022] Open
Abstract
Background Effective treatment options for nonresectable hepatic carcinoma (HC) in dogs are limited. Hypothesis/Objective Objectives were to report outcomes, complications, and tumor responses via computed tomography (CT) assessment after drug‐eluting bead transarterial chemoembolization (DEB‐TACE) for nonresectable HC in dogs. The authors hypothesized that major complications would be uncommon and short‐term CT assessment would demonstrate stable disease or partial response. Animals Client‐owned dogs (n = 16) with nonresectable HC. Methods Prospective, single‐arm clinical trial. Drug‐eluting bead transarterial chemoembolization was performed to varying levels of blood flow stasis. Computed tomography imaging was compared before and approximately 12 weeks after initial treatment. Results Drug‐eluting bead transarterial chemoembolization was successfully administered in all attempts. Based on percent change in elliptical tumor volume response (mL), stable disease (8/13; 62%) was the most common outcome followed by partial response (3/13; 23%) and progressive disease (2/13; 15%) with a median of 74 days (range, 39‐125) after initial treatment. Median tumor volume (mL) after DEB‐TACE decreased in volume by 13% (range, 56% decrease to 77% increase). Mild complications consistent with postembolization syndrome occurred after 7/27 (26%) treatments. Major complications occurred after 3/27 (11%) treatments: hepatic abscess/septicemia (2) and cholecystitis/death (1), resulting in treatment‐induced death after 2/27 (7%) treatments. Median survival time after treatment was 337 days (range, 22‐1061). Dogs with a presenting complaint of weight loss (P = .02) had a significantly shorter median survival time (126 days; range, 46‐337) than those dogs without prior history of weight loss (582 days; range, 22‐1061). Conclusions Drug‐eluting bead transarterial chemoembolization for nonresectable HC is a feasible procedure, which promoted stable disease or partial response in 85% of dogs in this study sample.
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Affiliation(s)
- Cleo P Rogatko
- The Animal Medical Center, New York, New York, USA.,Veterinary Surgical Centers, Vienna, Virginia, USA
| | - Chick Weisse
- The Animal Medical Center, New York, New York, USA
| | - Tobias Schwarz
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, United Kingdom
| | | | - Marcio A Diniz
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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24
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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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25
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Shiwani TH, Shiwani H. Intra-arterial anaesthetics for pain control in arterial embolisation procedures: a systematic review and meta-analysis. CVIR Endovasc 2021; 4:6. [PMID: 33399961 PMCID: PMC7785604 DOI: 10.1186/s42155-020-00198-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023] Open
Abstract
Purpose A systematic review to determine the effectiveness of intra-arterial anaesthetics on post- operative pain and opioid analgesia requirements in arterial embolisation procedures. Materials and methods A systematic review of the literature was performed (Embase, PubMed, MEDLINE and the Cochrane Library) from inception to 10th August 2020. Randomised controlled trials (RCTs) and cohort studies that utilised intra-arterial anaesthesia during an embolisation procedure for the purposes of pain control were included. Eligibility was assessed by two investigators independently. Results Eight hundred fifty-nine candidate articles were identified, and 9 studies met the inclusion criteria (6 RCTs and 3 retrospective cohort studies). Four studies were of hepatic chemoembolisation and 5 were of uterine artery embolisation. Five hundred twenty-nine patients were treated in total. All studies used lidocaine as the anaesthetic with doses ranging from 20 to 200 mg, and the anaesthetic was delivered varyingly before, during or after embolisation. Pain intensity was converted to a numeric scale from 0 to 10, and opioid doses were converted to milligram morphine equivalent doses. A random-effects meta-analysis model was used to analyse the results of RCTs, and the results of cohort studies were summarised with a narrative synthesis. The meta-analyses suggested that pain scores were reduced by a mean of 1.02 (95% CI − 2.34 to 0.30; p = 0.13) and opioid doses were reduced by a mean of 7.35 mg (95% CI, − 14.77, 0.06; p = 0.05) in the intervention group however neither finding was statistically significant. No serious adverse events were reported. Conclusion Intra-arterial anaesthetic may slightly reduce pain intensity and post-operative opioid consumption following embolisation, however the results are not statistically significant. There is very limited data available on the effect of anaesthetic on length of hospital admission. Whilst no serious adverse events were reported, there are some concerns regarding the effect of lidocaine on the technical success of embolisation procedures that preclude our recommendation for routine use in embolisation procedures. High quality randomised controlled trials are required to elucidate the dose-response effect of lidocaine on opioid consumption and pain following embolisation, particularly in the first few hours post-operatively, as well as effects on duration of hospital stay. Supplementary Information The online version contains supplementary material available at 10.1186/s42155-020-00198-z.
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Affiliation(s)
| | - Hunain Shiwani
- Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
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26
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Role of N-acetyl Cysteine in Post-transarterial Chemoembolization Transaminitis in Hepatocellular Carcinoma: A Single-center Experience. J Clin Exp Hepatol 2021; 11:299-304. [PMID: 33994712 PMCID: PMC8103334 DOI: 10.1016/j.jceh.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Transarterial chemoembolization (TACE) is the most common locoregional therapy for hepatocellular carcinoma (HCC). Postembolization syndrome is not an uncommon complication. At present, there is no specific treatment for management of this complication. We aimed to study the role of N-acetyl cysteine (NAC), an antioxidant, in management of this complication. METHODS In a prospective observational study, consecutive patients with HCC undergoing TACE from January 2016 to January 2017 were included. Patients with postembolization syndrome, defined as an elevation of transaminase levels more than 3-4 times the upper limit of normal, were administered intravenous NAC for 72 h (150 mg/kg for 1 h, then 12.5 mg/kg/h for 4 h, and continuous infusion 6.25 mg/h for the remaining 67 h). The other group received only supportive standard of care. The primary end point was reduction in post-TACE transaminitis. RESULTS Of 112 patients with HCC, 53 (47.3%) received NAC. The majority were cirrhotics in both the groups. Both groups were well matched in demographic, laboratory, and tumor characteristics. In the NAC group, there was significant reduction in Aspartate transaminase (AST) and Alanine transaminase (ALT) levels from day 1 to day 3 (p = 0.000) compared with the non-NAC group, with no significant change in bilirubin or international normalized ratio levels. The duration of hospital stay was similar in both the groups. None had any major adverse events to NAC. CONCLUSION This is a prospective, single-center experience, showing that early initiation of N-acetyl cysteine in those with post-TACE embolization syndrome reduces the transaminase level significantly.
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Key Words
- AFP, alpha-fetoprotein
- ANOVA, analysis of variance
- BCLC, Barcelona Clinic Liver Cancer
- CT, computed tomography
- HCC, hepatocellular carcinoma
- IL, interleukin
- INR, international normalized ratio
- LT, liver transplantation
- NAC, N-acetyl cysteine
- PES, postembolization syndrome
- TACE, Transarterial chemoembolization
- chronic liver disease
- liver cancer
- liver transplant
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27
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Shehta A, Lee JM, Suh KS, Kim HC, Hong SK, Cho JH, Yi NJ, Lee KW. Bridging and downstaging role of trans-arterial radio-embolization for expected small remnant volume before liver resection for hepatocellular carcinoma. Ann Hepatobiliary Pancreat Surg 2020; 24:421-430. [PMID: 33234744 PMCID: PMC7691198 DOI: 10.14701/ahbps.2020.24.4.421] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023] Open
Abstract
Backgrounds/Aims To evaluate our initial experience of bridging role of trans-arterial radio-embolization (TARE) before major hepatectomy for hepatocellular carcinoma (HCC) in risky patients with small expected remnant liver volume (ERLV). Methods We reviewed the data of patients with HCC who underwent major hepatectomy after TARE during the period between March and December 2017. Patients included had uni-lobar large HCC (>5 cm) requiring major hepatectomy with small ERLV. Results Five patients were included in our study. All patients were Child Pugh class A. A single session of TARE was applied in all patients. None developed any adverse events related to irradiation. The mean tumor size at baseline was 8.4 cm and 6.1 cm after TARE (p=0.077). The mean % of tumor shrinkage was 24.5%. ERLV improved from 354.6 ml at baseline to 500.8 ml after TARE (p=0.012). ERLV percentage improved from 27.2% at baseline to 38.1% after TARE (p=0.004). The mean % of ERLV was 39.5%. The mean interval time between TARE and resection was 99.6 days. Four patients (80%) underwent right hemi-hepatectomy and one patient (20%) underwent extended right hemi-hepatectomy. The mean operation time was 151 minutes, and mean blood loss was 56 ml. The mean hospital stay was 13.8 days, and one patient (20%) developed postoperative morbidity. After a mean follow-up of 15 months, all patients were alive with no recurrence. Conclusions Yttrium-90 TARE can play a bridging role before major hepatectomy for borderline resectable HCC in risky patients with small ERLV.
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Affiliation(s)
- Ahmed Shehta
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Liver Transplantation Unit, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - Jeong-Moo Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Hyung Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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28
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Manas D, Bell JK, Mealing S, Davies H, Baker H, Holmes H, Hubner RA. The cost-effectiveness of TheraSphere in patients with hepatocellular carcinoma who are eligible for transarterial embolization. Eur J Surg Oncol 2020; 47:401-408. [PMID: 32958370 DOI: 10.1016/j.ejso.2020.08.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The aim of the study is to estimate the cost-effectiveness of TheraSphere against other embolic treatments in a population with early to intermediate stage hepatocellular carcinoma (HCC) who are unresectable at presentation and are eligible for transarterial embolization (TAE), conventional transarterial chemoembolization (cTACE) or drug-eluting bead TACE (DEB-TACE). MATERIALS AND METHODS A Markov model was constructed using a UK National Health Service (NHS) perspective, a 20-year time horizon, and four-week cycles. The eight health states included 'watch and wait', 'transplantation' (pre-, post and post (No HCC)), 'resection', 'no HCC other', 'pharmacological management' and 'death'. Clinical data were sourced from literature and expert opinion. Resource use and costs were reflective of the NHS, and benefits were quantified using Quality-Adjusted Life Years (QALYs), with utility weights sourced from literature. Comparators were TAE, cTACE and DEB-TACE. The primary output was the Incremental Cost-Effectiveness Ratio (ICER) expressed as cost per QALY gained. An ICER of under £20,000/QALY gained for an intervention is cost-effective and represents efficient use of healthcare resources. Extensive deterministic and probabilistic sensitivity analyses were undertaken. RESULTS TheraSphere patients were predicted to gain 0.7 additional QALYs compared to all other treatments. The base case ICERs for TheraSphere were £17,300, £17,279 and £23,020 per QALY gained compared to TAE, cTACE and DEB-TACE, respectively. In the TheraSphere cohort, 87% more patients were predicted to achieve downstaging compared to all other treatment options. CONCLUSIONS This study indicates that treatment with TheraSphere is a potentially cost-effective option for patients with early to intermediate stage HCC.
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Affiliation(s)
- Derek Manas
- Newcastle upon Tyne NHS Trust, Freeman Hospital Freeman Road High Heaton Newcastle upon Tyne, NE7 7DN, UK.
| | - Jon K Bell
- The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX, UK.
| | - Stuart Mealing
- York Health Economics Consortium, Enterprise House, University of York, York, YO10 5NQ, UK.
| | - Heather Davies
- York Health Economics Consortium, Enterprise House, University of York, York, YO10 5NQ, UK.
| | - Hannah Baker
- York Health Economics Consortium, Enterprise House, University of York, York, YO10 5NQ, UK.
| | - Hayden Holmes
- York Health Economics Consortium, Enterprise House, University of York, York, YO10 5NQ, UK.
| | - Richard A Hubner
- The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX, UK.
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29
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Arslan M, Degirmencioglu S. Risk Factors for Postembolization Syndrome After Transcatheter Arterial Chemoembolization. Curr Med Imaging 2020; 15:380-385. [PMID: 31989907 DOI: 10.2174/1573405615666181122145330] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/04/2018] [Accepted: 11/10/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Transarterial Chemoembolization (TACE) is a minimally invasive treatment in managing unresectable liver primary neoplasms or liver metastases. Postembolization Syndrome (PES) is the most common adverse effect after TACE procedures. OBJECTIVE We investigate the risk factors for the development of PES after TACE therapy in patients with primary or metastatic liver tumors. METHODS In a retrospective analysis of 163 patients who underwent TACE between 01/01/2012 and 31/01/2018, patients that were given medication due to pain, fever, nausea or vomiting were evaluated and noted with PES. Analyses were made to evaluate factors such as age, gender, chemotherapy agent and dose, tumor size, tumor type, a particle used for embolization, multiple tumor treatments and selective application of the procedure, which may lead to PES after TACE. RESULTS In a total of 316 patients, PES was observed at a rate of 55 percent after TACE. Tumor size, number of tumors treated and adopting super selective fashion in the procedure were found to be related to the development of PES. No relationship was found between age, gender, presence of ascites, tumor type, size of embolic agent and drug type and the development of PES. CONCLUSION A treated tumor measuring >5 cm, treating more than one tumor, and the failure to perform the procedure in a super selective fashion increase the risk of PES development after TACE.
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Affiliation(s)
- Muhammet Arslan
- Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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30
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Peng C, Teng W, Hsieh Y, Jeng W, Huang C, Lui K, Hung C, Chen Y, Lin C, Lin C, Lin S, Sheen I. Postembolization fever after transarterial chemoembolization is a sign of unfavorable therapeutic response in hepatocellular carcinoma patients. ADVANCES IN DIGESTIVE MEDICINE 2020. [DOI: 10.1002/aid2.13182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Chien‐Wei Peng
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Wei Teng
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Yi‐Chung Hsieh
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Wen‐Juei Jeng
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Chien‐Hao Huang
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Kar‐Wai Lui
- College of Medicine, Chang Gung University Taipei Taiwan
- Department of RadiologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
| | - Chen‐Fu Hung
- College of Medicine, Chang Gung University Taipei Taiwan
- Department of RadiologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
| | - Yi‐Cheng Chen
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Chen‐Chun Lin
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Chun‐Yen Lin
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Shi‐Ming Lin
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - I‐Shyan Sheen
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
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31
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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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32
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Mähringer-Kunz A, Wagner F, Hahn F, Weinmann A, Brodehl S, Schotten S, Hinrichs JB, Düber C, Galle PR, Pinto Dos Santos D, Kloeckner R. Predicting survival after transarterial chemoembolization for hepatocellular carcinoma using a neural network: A Pilot Study. Liver Int 2020; 40:694-703. [PMID: 31943703 DOI: 10.1111/liv.14380] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/20/2019] [Accepted: 01/08/2020] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS Deciding when to repeat and when to stop transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) can be difficult even for experienced investigators. Our aim was to develop a survival prediction model for such patients undergoing TACE using novel machine learning algorithms and to compare it to conventional prediction scores, ART, ABCR and SNACOR. METHODS For this retrospective analysis, 282 patients who underwent TACE for HCC at our tertiary referral centre between January 2005 and December 2017 were included in the final analysis. We built an artificial neural network (ANN) including all parameters used by the aforementioned risk scores and other clinically meaningful parameters. Following an 80:20 split, the first 225 patients were used for training; the more recently treated 20% were used for validation. RESULTS The ANN had a promising performance at predicting 1-year survival, with an area under the ROC curve (AUC) of 0.77 ± 0.13. Internal validation yielded an AUC of 0.83 ± 0.06, a positive predictive value of 87.5% and a negative predictive value of 68.0%. The sensitivity was 77.8% and specificity 81.0%. In a head-to-head comparison, the ANN outperformed the aforementioned scoring systems, which yielded lower AUCs (SNACOR 0.73 ± 0.07, ABCR 0.70 ± 0.07 and ART 0.54 ± 0.08). This difference reached significance for ART (P < .001); for ABCR and SNACOR significance was not reached (P = .143 and P = .201). CONCLUSIONS Artificial neural networks could be better at predicting patient survival after TACE for HCC than traditional scoring systems. Once established, such prediction models could easily be deployed in clinical routine and help determine optimal patient care.
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Affiliation(s)
- Aline Mähringer-Kunz
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Franziska Wagner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Arndt Weinmann
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Clinical Registry Unit (CRU), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sebastian Brodehl
- Institute for Informatics, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sebastian Schotten
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jan B Hinrichs
- Department of Interventional and Diagnostic Radiology, Hannover Medical School, Hanover, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Peter R Galle
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | | | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Siramolpiwat S, Punjachaipornpon T, Pornthisarn B, Vilaichone RK, Chonprasertsuk S, Tangaroonsanti A, Bhanthumkomol P, Phumyen A, Yasiri A, Kaewmanee M. N-Acetylcysteine Prevents Post-embolization Syndrome in Patients with Hepatocellular Carcinoma Following Transarterial Chemoembolization. Dig Dis Sci 2019; 64:3337-3345. [PMID: 31073737 DOI: 10.1007/s10620-019-05652-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Post-embolization syndrome is a common complication after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). N-acetylcysteine (NAC) is known to ameliorate liver damage from several causes. AIM To determine the efficacy of intravenous NAC in the prevention of post-embolization syndrome in HCC patients following TACE. METHODS In this study, patients with HCC admitted for TACE were prospectively enrolled. All patients were randomized stratified by Child A or B to receive NAC or placebo. The NAC group received intravenous NAC 24 h prior to TACE (150 mg/kg/h for 1 h followed by 12.5 mg/kg/h for 4 h, then continuous infusion 6.25 mg/h for 48 h after the procedure). The placebo group received an infusion of 5% glucose solution until 48 h after procedure. The post-embolization syndrome was defined as: T ≥ 38.5 c and serum ALT > 3 times of pretreatment value. RESULTS In total, 111 HCC patients were enrolled; 57 were randomly assigned to NAC group and 54 to placebo group. The incidence of post-embolization syndrome was lower in NAC group (24.6%) compared to placebo group (48.2%); P = 0.01. On multivariate analysis, receiving IV NAC (P = 0.03) and HCC diameter (P < 0.01) were associated with developing post-embolization syndrome. Post-TACE liver decompensation was documented in 26/111 (23.4%) patients. There was no difference in the incidence of post-TACE liver decompensation between NAC and placebo group. CONCLUSIONS In this study, intravenous NAC administration reduces the incidence of post-embolization syndrome after TACE in patients with HCC. However, it does not prevent post-TACE liver decompensation. TRIAL REGISTRATION NUMBER This study was registered with Thai Clinical Trial Registry (TCTR20150313002).
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Affiliation(s)
- Sith Siramolpiwat
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand. .,Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.
| | - Thanachai Punjachaipornpon
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Bubpha Pornthisarn
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Ratha-Korn Vilaichone
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.,Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Soonthorn Chonprasertsuk
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Anupong Tangaroonsanti
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Patommatat Bhanthumkomol
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Achara Phumyen
- Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Atipat Yasiri
- Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Mayurachat Kaewmanee
- Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
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Khalaf AM, Fuentes D, Morshid A, Kaseb AO, Hassan M, Hazle JD, Elsayes KM. Hepatocellular carcinoma response to transcatheter arterial chemoembolisation using automatically generated pre-therapeutic tumour volumes by a random forest-based segmentation protocol. Clin Radiol 2019; 74:974.e13-974.e20. [PMID: 31521326 DOI: 10.1016/j.crad.2019.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/31/2019] [Indexed: 01/03/2023]
Abstract
AIM To demonstrate the feasibility of correlating pre-therapeutic volumes and residual liver volume (RLV) with clinical outcomes: time to progression (TTP) and overall survival (OS) in hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolisation (TACE). MATERIALS AND METHODS TTP was calculated from a database of 105 patients, receiving first-line treatment with TACE. TTP cut-off for stratifying patients into responders and non-responders was 28 weeks. Pre-treatment tumour and liver volumes were correlated with the TTP and OS following treatment. Univariate cox-regression model was used to assess whether these volumes could predict TTP and/or OS. Kaplan-Meier analysis with log-rank test was used to compare the TTP between high and low volume groups for viable, necrotic, and total tumour. Kaplan-Meier analysis was performed comparing the OS of 10 patients with the longest TTP (mean=122 weeks) in the responder group and 10 patients with the shortest TTP (mean=7 weeks) in the non-responder group. RESULTS HCC in high tumour volume groups had a shorter TTP than lesions in low tumour volume groups (p=0.05, p=0.04, p=0.02, for enhancing, non-enhancing, total tumour groups, respectively). A negative (correlation coefficient [CC] 0.3) linear correlation between TTP and tumour volumes, and a positive linear correlation between TTP and residual liver volumes were also demonstrated (CC 0.3). Patients with the longest TTP had a higher OS than with the shortest TTP (p=0.03). CONCLUSION This demonstrates the feasibility of predicting treatment response of HCC to TACE using volumetric measurements of pre-treatment lesion and the feasibility of correlating RLV with TACE outcome data in HCC patients.
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Affiliation(s)
- A M Khalaf
- Department of Imaging Physics, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - D Fuentes
- Department of Imaging Physics, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - A Morshid
- Department of Imaging Physics, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - A O Kaseb
- Department of Gastrointestinal Oncology, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - M Hassan
- Department of Gastrointestinal Oncology, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - J D Hazle
- Department of Imaging Physics, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - K M Elsayes
- Department of Diagnostic Radiology, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA.
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Morshid A, Elsayes KM, Khalaf AM, Elmohr MM, Yu J, Kaseb AO, Hassan M, Mahvash A, Wang Z, Hazle JD, Fuentes D. A machine learning model to predict hepatocellular carcinoma response to transcatheter arterial chemoembolization. Radiol Artif Intell 2019; 1:e180021. [PMID: 31858078 PMCID: PMC6920060 DOI: 10.1148/ryai.2019180021] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 05/25/2019] [Accepted: 08/05/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE Some patients with hepatocellular carcinoma (HCC) are more likely to experience disease progression despite transcatheter arterial chemoembolization (TACE) treatment, and thus would benefit from early switching to other therapeutic regimens. We sought to evaluate a fully automated machine learning algorithm that uses pre-therapeutic quantitative computed tomography (CT) image features and clinical factors to predict HCC response to TACE. MATERIALS AND METHODS Outcome information from 105 patients receiving first-line treatment with TACE was evaluated retrospectively. The primary clinical endpoint was time to progression (TTP) based on follow-up CT radiological criteria (mRECIST). A 14-week cutoff was used to classify patients as TACE-susceptible (TTP ≥14 weeks) or TACE-refractory (TTP <14 weeks). Response to TACE was predicted using a random forest classifier with the Barcelona Clinic Liver Cancer (BCLC) stage and quantitative image features as input as well as the BCLC stage alone as a control. RESULTS The model's response prediction accuracy rate was 74.2% (95% CI=64%-82%) using a combination of the BCLC stage plus quantitative image features versus 62.9% (95% CI= 52%-72%) using the BCLC stage alone. Shape image features of the tumor and background liver were the dominant features correlated to the TTP as selected by the Boruta method and were used to predict the outcome. CONCLUSION This preliminary study demonstrates that quantitative image features obtained prior to therapy can improve the accuracy of predicting response of HCC to TACE. This approach is likely to provide useful information for aiding HCC patient selection for TACE.
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Affiliation(s)
- Ali Morshid
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Khaled M. Elsayes
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Ahmed M. Khalaf
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Mohab M. Elmohr
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Justin Yu
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Ahmed O. Kaseb
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Manal Hassan
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Armeen Mahvash
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - Zhihui Wang
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - John D. Hazle
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
| | - David Fuentes
- From the Departments of Imaging Physics (A. Morshid, A.M.K., M.M.E., J.Y., J.D.H., D.F.), Diagnostic Radiology (K.M.E.), Gastrointestinal Oncology (A.O.K., M.H.), and Interventional Radiology (A. Mahvash), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex (Z.W.)
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Lucatelli P, Argirò R, De Rubeis G, Rocco B, Corradini SG, Corona M, Nardis PG, Saba L, Mennini G, Fiorentino F, Corsi A, Catalano C, Bezzi M. Polyethylene Glycol Epirubicin-Loaded Transcatheter Arterial Chemoembolization Procedures Utilizing a Combined Approach with 100 and 200 μm Microspheres: A Promising Alternative to Current Standards. J Vasc Interv Radiol 2019; 30:305-313. [DOI: 10.1016/j.jvir.2018.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023] Open
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Wang ZX, Li L, Tao FY. Health education helps to relieve postembolization pain during hepatic arterial chemoembolization therapy. J Pain Res 2018; 11:2115-2121. [PMID: 30319286 PMCID: PMC6169766 DOI: 10.2147/jpr.s166333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim Psychological intervention has been proved a complementary approach to drug analgesia. Another study suggested that health knowledge is associated with psychological symptoms in patients with liver cancer. This study is conducted to assess whether improving the health education (HE) alleviates the postembolization pain during transarterial chemoembolization (TACE). Materials and methods One hundred and fifteen patients, who required TACE for hepatocellular carcinoma (HCC) and suffered postembolization pain, were randomized into control group (n=63) and HE group (n=52). The health knowledge was scaled with the health knowledge questionnaire (HKQ). The postembolization pain was scored using a 0–10 numeric rating scale (NRS-10) after arterial embolization in both groups. Results There were no statistical differences between male and female in all HKQ scores (P>0.05). The HKQ scores of young people (≤45 years old) were significantly higher than those of elders (>45 years old; P<0.05). After teaching HE, the HKQ scores were significantly increased in patients of the HE group (P<0.01). The postembolization pain score in the HE group was significantly lower than that in the control group (P<0.05). The HKQ scores of question 1, 3, and total were negatively correlated with the pain score in this sample (P<0.05). Conclusion Improving the HE among HCC patients before TACE is beneficial for the pain relief during interventional procedure.
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Affiliation(s)
- Zi Xuan Wang
- Department of Interventional Radiology, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China
| | - Lin Li
- Department of Interventional Radiology, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China
| | - Feng Ying Tao
- Department of Oncology, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China,
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Quality of life in patients undergoing repetitive TACE for the treatment of intermediate stage HCC. J Cancer Res Clin Oncol 2018; 144:1991-1999. [PMID: 30008024 DOI: 10.1007/s00432-018-2704-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 07/05/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE With a limited overall survival (OS) of 20 months in patients diagnosed with intermediate stage hepatocellular carcinoma (HCC), the preservation of quality of life (QoL) during transarterial chemoembolization (TACE) procedures remains a primary goal. The aim of our study was to evaluate the change in QoL amongst patients undergoing repetitive TACE and to identify specific risk factors that may predict change in QoL. METHODS QoL was assessed in 82 patients undergoing at least two TACE, before and 14 days after TACE, using validated EORTC QLQ-C30 and EORTC HCC18 questionnaires. Tumour response was assessed using established response criteria. Laboratory and clinical parameters were analysed. RESULTS Functional scores decreased due to first TACE treatment (p < 0.01), conversely symptom scores increased significantly (p < 0.01). During repetitive TACE no statistically significant changes were observed. Higher Global Health- and Physical Functioning scores at baseline were identified as independent prognostic factors for greater decrease in QoL. Tumour response did not alter QoL at all. Furthermore higher symptom scales including pain (p = 0.00), nausea and vomiting (p = 0.00) and fever (p < 0.01 for repetitive TACE) at baseline were predictive of a significantly lesser increase of symptom severity, and a greater reduction in pain during a course of TACE. Higher C-reactive protein (CRP) at baseline and female gender were associated with a greater decrease of functional scales and increase of symptom scales. CONCLUSION QoL amongst patients receiving repetitive TACE showed neither significant nor clinically relevant changes over time. Pre-treatment assessment of QoL-scores, clinical and laboratory parameters can improve patient selection for TACE whilst optimizing QoL.
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Liu Y, Huang W, He M, Lian H, Guo Y, Huang J, Zhou J, Zhu K. Efficacy and Safety of CalliSpheres ® Drug-Eluting Beads Transarterial Chemoembolization in Barcelona Clinic Liver Cancer Stage C Patients. Oncol Res 2018; 27:565-573. [PMID: 30005719 PMCID: PMC7848450 DOI: 10.3727/096504018x15313896322888] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study aimed to investigate the efficacy and safety of drug-eluting beads transarterial chemoembolization (DEB-TACE) treatment in Barcelona Clinic Liver Cancer (BCLC) stage C liver cancer patients. In 39 patients with BCLC stage C liver cancer, after the first cycle of DEB-TACE, 2 (5.1%) and 24 (61.5%) patients achieved complete response (CR) and partial response (PR) to give an overall objective response rate (ORR) of 66.7%. With respect to the second cycle of therapy, the ORR was higher in patients receiving DEB-TACE compared with those receiving cTACE (57.1% vs. 11.1%). After the first cycle of DEB-TACE treatment, the percentages of abnormal albumin (ALB), total protein (TP), total bilirubin (TBIL), and alanine aminotransferase (ALT) worsened at 1 week and recovered at 1 month. The number of patients with abnormal aspartate aminotransferase (AST) did not increase at 1 week but elevated at 1 month. After the second cycle of DEB-TACE or cTACE treatment, no difference was observed between cTACE and DEB-TACE in terms of all adverse events (AEs) at all visits, and most of the AEs did not change after the second cycle in both groups. The most common AEs after the first and second treatment cycles were pain, fever, and nausea/vomiting. These results demonstrate that DEB-TACE offers patients with BCLC stage C liver cancer a clinically active short-term treatment that is safe and relatively well tolerated.
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Affiliation(s)
- Yaohong Liu
- Department of Minimally Invasive Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Wensou Huang
- Department of Minimally Invasive Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Mingji He
- Department of Minimally Invasive Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Hui Lian
- Department of Minimally Invasive Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Yongjian Guo
- Department of Minimally Invasive Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Jingjun Huang
- Department of Minimally Invasive Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Jingwen Zhou
- Department of Minimally Invasive Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Kangshun Zhu
- Department of Minimally Invasive Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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Piscaglia F, Tovoli F, Pini P, Salvatore V. A new horizon in the prevention of the postembolization syndrome after transcatheter arterial chemoembolization for hepatocellular carcinoma. Hepatology 2018; 67:467-469. [PMID: 28901566 DOI: 10.1002/hep.29517] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 09/06/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Fabio Piscaglia
- Unit of Internal Medicine, General and University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Francesco Tovoli
- Unit of Internal Medicine, General and University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Patrizia Pini
- Unit of Internal Medicine, General and University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Veronica Salvatore
- Unit of Internal Medicine, General and University Hospital S. Orsola-Malpighi, Bologna, Italy
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Tang CW, Zhu M, Feng WM, Bao Y, Zheng YY. Chinese herbal medicine, Jianpi Ligan decoction, improves prognosis of unresectable hepatocellular carcinoma after transarterial chemoembolization: a retrospective study. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:2461-6. [PMID: 27536066 PMCID: PMC4977068 DOI: 10.2147/dddt.s113295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective This study aimed to investigate the efficacy of Jianpi Ligan decoction (JLD) as an adjuvant therapy for patients with unresectable hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE). Methods From March 2007 to March 2013, 103 patients with unresectable HCC who underwent TACE in our center were included in this retrospective study. Among the 103 patients, 53 patients accepted JLD along with TACE (JLD group) and 50 patients accepted TACE alone (control group). Indices including complication, toxicity, treatment success rate, and long-term survival were obtained for analysis and comparison. Results There was no significant difference in patient characteristics between the two groups. No procedure-related deaths or encephalopathy occurred. Fewer patients from the JLD group experienced constipation (7/53 vs 15/50, P=0.0377), abdominal bloating (5/53 vs 12/50, P=0.0466), and lack of appetite (35/53 vs 42/50, P=0.0360). The JLD group had lesser and lighter hepatic toxicity (P=0.0265) and gastrointestinal toxicity (P=0.0445) such as nausea and vomiting. The JLD group had a significantly higher treatment success rate than the control group (51/53 vs 40/50, P=0.0103). Three-year overall survival probability was significantly higher in the JLD group than in the control group (37.74% vs 26.00%; hazard ratio [HR] 0.6171; 95% confidence interval [CI], 0.3832–0.9938; P=0.0365 by log-rank test). No significant difference was found in 3-year overall survival probability (39.22% vs 32.50%; HR, 0.7449; 95% CI, 0.4398–1.2614; P=0.2491 by log-rank test) or 3-year intrahepatic recurrence-free survival probability in patients who achieved treatment success (37.25% vs 30.00%; HR, 0.7280; 95% CI, 0.4332–1.2233; P=0.2087 by log-rank test) between the two groups. Conclusion Application of JLD was effective for reduction of side effects and improvement of long-term survival for patients with unresectable HCC treated by TACE.
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Affiliation(s)
| | | | | | | | - Yin Yuan Zheng
- Department of Radiology, First People's Hospital Affiliated to Huzhou University Medical College, Huzhou, People's Republic of China
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