TABLE 1 - uploaded by A. Marinis
Content may be subject to copyright.
Source publication
The investigation of post embolization syndrome (PES) in patients with hepatocellular carcinoma (HCC) after treatment with doxorubicin loaded DC Bead (DEB-DOX).
The study included 237 patients treated with sequential DEB-TACE performed at set time intervals every two months until 3 sessions/6 month f-u. Patients were ECOG 0-1, Child-Stage-A (n=116,...
Context in source publication
Similar publications
Background:
Transcatheter arterial chemoembolisation (TACE) is the treatment of choice for intermediate stage hepatocellular carcinoma (HCC). Doxorubicin-loaded drug-eluting beads (DEB)-TACE is expected to improve the performance of conventional TACE (cTACE). The aim of this study was to compare DEB-TACE with cTACE in terms of time-to-tumour progr...
Chemoembolization with lipiodol (TACE) improves survival of selected patients with unresectable hepatocellular carcinoma (HCC), but results in substantial toxicity. To improve treatment tolerance, we conducted this phase II study using doxorubicin-loaded beads (DC Beads®) delivered by selective transcatheter arterial chemoembolization (DEB-TACE). W...
Background
According to Barcelona Clinic Liver Cancer classification transarterial chemoembolization is indicated in patients with Hepatocellular Carcinoma in the intermediate stage. Drug-eluting microspheres can absorb and release the chemotherapeutic agent slowly for 14 days after its intra-arterial administration. This type of transarterial chem...
Purpose:
To evaluate the diagnostic performance of deep learning with a multichannel fusion three-dimensional convolutional neural network (MCF-3DCNN) in the differentiation of the pathologic grades of hepatocellular carcinoma (HCC) based on dynamic contrast-enhanced magnetic resonance images (DCE-MR images).
Methods and materials:
Fifty-one his...
Citations
... Therefore, it is extremely important to effectively predict and control PES. The incidence of PES after TACE has been reported differently in the related reports 15,16 , which may be related to different general conditions, intraoperative use of embolic agents, and methods of data collection from TACE patients included in different literature. In this study, 180 patients were included, of which 106 cases (58.89%) developed PES. ...
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.
... However, adverse events after TACE have a prevalence of 87% [9]. Among them, abdominal pain has the most serious effect on the quality of life of patients, causing anxiety. ...
Transarterial chemoembolisation (TACE) is a standard therapy for hepatocellular carcinoma (HCC). However, adverse events, including abdominal pain, are common. This study aimed to investigate and verify the feasibility of a nomogram model to predict severe abdominal pain after first conventional TACE (cTACE) among patients with HCC. Patients with HCC treated with cTACE between October 28, 2019, and August 5, 2022, at a single centre were enrolled (n=216). Patients were divided into training and validation cohorts (ratio, 7:3). A visual analogue scale score between 7 and 10 was considered severe abdominal pain. A total of 127 (58.8%) patients complained of severe abdominal pain after first cTACE treatment. The nomogram considered age and tumour number and size. The nomogram demonstrated good discrimination, with a C-index of 0.749 (95% confidence interval [CI], 0.617, 0.881). Further, the C-index in the validation cohort reached 0.728 (95% CI: 0.592, 0.864). The calibration curves showed ideal agreement between the prediction and real observations, and the nomogram decision curve analysis performed well. The nomogram model can provide an accurate prediction of severe abdominal pain in patients with HCC after first cTACE, aiding in the personalization of pain management and providing novel insights into hospital nursing.
... The safety assessment included documentation of clinical laboratory tests, physical examinations, and measurements of vital signs. In the two groups, liver function tests within 7 days after the first TACE procedure were recorded and adverse events (AEs) within 1 month were reported according to the Society of Interventional Radiology guidelines and graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 [13,14]. ...
Objectives:
To compare the efficacy, overall survival (OS) and safety of drug-eluting beads-TACE (DEB-TACE) and C-TACE as initial treatment in advanced hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus (mPVTT).
Methods:
The medical records of consecutive advanced HCC patients with mPVTT who underwent initial DEB-TACE or C-TACE from September 2015 to October 2021 were retrospectively evaluated. Treatment crossover was allowed in this retrospective research. The adverse events, disease control rate (DCR), time to tumor progression (TTP) and OS of patients who underwent DEB-TACE were compared with those of patients who underwent C-TACE.
Results:
Eighty-three patients were included: 42 patients in DEB-TACE group and 41 patients in C-TACE group. DEB-TACE could be safely performed in HCC patients with mPVTT, and they gained a better DCR than those submitted to the C-TACE (76.2% vs. 53.7%, P = 0.031), which might have resulted in longer TTP (median TTP: 9.0 months vs. 3.0 months, P < 0.001). Furthermore, DEB-TACE showed significant OS benefits compared with C-TACE (median OS: 12.0 months vs. 5.0 months, P < 0.001). DEB-TACE, absence of arterioportal shunts (APS), leisons with capsular non-infiltration were found to be independent prognostic factors for better OS. Furthermore, subgroup analysis proved that patients with good DCR gained longer OS in DEB-TACE group.
Conclusions:
DEB-TACE could be safely performed and improve the DCR of HCC patients with mPVTT, which resulting in longer TTP and OS, compared with C-TACE.
... Adverse events (AEs) within 1 months after TACE were performed and reported according to the Society of Interventional Radiology guidelines [16,17]. Liver function tests after first DEM-TACE were also recorded, such as aspartate aminotransferase, alanine aminotransferase, total bilirubin, serum albumin and prothrombin time, were measured 1 month after the initial TACE procedure to evaluate the safety of DEM-TACE in HCC patients with PVTT. ...
Background
Conventional-transarterial chemoembolization (C-TACE) was proven to improve overall survival (OS) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT), drug-eluting microsphere-TACE (DEM-TACE) was supposed to provide more benefit than C-TACE in this respect.
Purpose
To compare the safety and efficacy between DEM-TACE and C-TACE as the initial treatment in HCC patients with PVTT and to identify prognostic factors of OS.
Methods
The medical records of advanced HCC patients with PVTT who underwent DEM-TACE or C-TACE as the initial thearpy from September 2015 with mean follow-up time 14.9 ± 1.2 (95% CI 12.6–17.2) months were retrospectively evaluated. A total of 97 patients were included, 49 patients in the DEM-TACE group and 48 in the C-TACE group. Adverse events (AEs) related to TACE were compared. Tumor and PVTT radiologic response, time to tumor progression (TTP) and OS were calculated and compared in both groups.
Results
Patients in DEM-TACE group had a better radiologic response (Tumr response: 89.8% vs. 75.0%; PVTT response: 85.7% vs. 70.8%; overall response: 79.6% vs. 58.3%, P = 0.024) and longer TTP (7.0 months vs. 4.0 months, P = 0.040) than patients in C-TACE group. A lower incidence of abdominal pain was found in the DEM-TACE group than in C-TACE group (21 vs. 31, P = 0.032), but there were no significant differences between DEM-TACE and C-TACE patients in any other AEs reported. When compared to C-TACE, DEM-TACE also showed significant OS benefits (12.0 months vs. 9.0 months, P = 0.027). DEM-TACE treatment, the absence of arterioportal shunt (APS), lower AFP value and better PVTT radiologic response were the independent prognostic factors for OS in univariate/multivariate analyses, which provided us with a guide for better patient selection.
Conclusions
Based on our retrospective study, DEM-TACE can be performed safely and might be superior to C-TACE as the initial treatment for HCC patients with PVTT.
Trial registration
Retrospectively registered.
... However, there is a high incidence of postoperative complications following TACE [11][12][13]. Pain is by far the most prevalent post-TACE complication, and it was often associated with a prolonged hospital stay [14,15]. As a result, postoperative pain management for TACE is viewed as one of the most important aspects of perioperative care. ...
... In our study, we found pain levels after TACE treatment for hepatic malignancies was correlated with tumor number, tumor size, microsphere volume, and operative time. Our results suggest that the tumor size of the largest tumor and number of tumors appear to be closely related to the occurrence of abdominal pain following TACE, which are consistent with previous reports [11,19]. Both Ichid et al. and Poon et al. found that tumor size and number were associated with a poorer long-term survival rate and higher TACE-related mortality [20,21]. ...
Purpose: Patients that experience severe postoperative pain are more reluctant to adhere the treatment. This study intends to identify the relevant risk factors and construct a scoring system for prediction.
Materials and methods: Liver cancer patients that underwent the first TACE treatment at the Second Affiliated Hospital of Chongqing Medical University from January 2019 to December 2020 were collected. The 11-point numerical rating scale (NRS-11) was utilized to evaluate the patient's pain level. The patients were randomly divided into a training and a validation cohort. In the training cohort, the correlation between each parameter and the pain level after TACE was evaluated through logistic regression, and a risk prediction model was established. Finally, the predictive power of the model was verified in the validation cohort.
Results: A total of 255 patients with liver cancer were included. In the training cohort, univariate analysis found postoperative pain was related to tumor number, tumor size, microsphere volume, and operation time. The above variables were then incorporated into the multivariate analysis to construct the prediction model, In the training and validation cohorts, the area under the curve (AUC) of the model used to predict moderate to severe pain response after TACE was 0.71 and 0.74, respectively. Additionally, we also created a nomogram for clinical use, patients with a total score greater than 72.90 are considered at a high risk of experiencing moderate to severe pain following TACE.
Conclusion: This study successfully constructed and validated a scoring system for predicting moderate to severe pain after an initial TACE treatment.
... [4] Long-term high fever not only increases the patient's hospital stay and medical costs, but also affects the efficacy of TACE treatment of liver cancer and life quality. [5] Therefore, studying the predictors of postinterventional fever in patients with HCC is of great practical importance to improve the quality of survival and reduce the number of hospital days and the cost of treatment. [6] Therefore, the aim of our study was to assess the efficacy, safety, and prognostic factors of drug-eluting bead transarterial chemoembolization (DEB-TACE) in Chinese HCC patients. ...
This study was to identify risk factors affecting postembolization fever (PEF) of CalliSpheres drug-eluting bead transarterial chemoembolization (DEB-TACE) in the treatment of primary hepatocellular carcinoma (HCC).
One hundred eighty-eight consecutive patients with HCC who underwent DEB-TACE with fever between June 2017 and May 2019 were included in this retrospective study. The patients were divided into 4 groups based on the severity of posttransarterial chemoembolization (TACE) fever according to the degrees of body temperature. Univariate analysis and multivariate logistics regression were performed to identify potential risk factors for post-TACE fever.
In the stepwise multiple regression analysis, pre-TACE blood urea, small particle size and Cental liqefction (P < .05) were independent risk factors of severe post-TACE fever (P < .05, respectively). Portal vein thrombosis (P < .01), Child-Pugh stage (P < .01), and cycles of DEB-TACE (P < .05) were independent risk factors for clinical death, PEF was not associated with clinical death (P = .754) and 6-month survival (P = .524) in the univariate analysis. Moreover, multivariate Cox regression was performed, and Child-Pugh stage (B vs A) (P = .040) and portal vein thrombosis (yes vs no) (P = .033) were independent factors predicting unfavorable overall survival in HCC patients.
Pre-TACE blood urea, small particle size, and Cental liqefction were significantly correlated with the occurrence fever after DEB-TACE. Therefore, these factors should be taken into full consideration for the relief of fever. However, PEF after D-TACE was not associated with clinical death and 6-month survival rate.
... There are some studies that calculate the Child-Pugh score, which calculates hepatic function and estimates severity of cirrhosis [12]. These studies used the score as inclusion criteria for TACE, using only patients in Child-Pugh class A or B [13,14]. Patients in class A may have better long-term outcomes than those in class B [13,15]. ...
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.
... Lobar embolization, on the other hand, allows for the delivery of microspheres to virtually all vessels supplying metastatic lesions, but exposes the entire liver parenchyma to the negative impact of irinotecan-loaded microspheres, which may result in more frequent occurrence of side effects and complications including PES (postembolization syndrome). These relationships have been assessed previously with chemoembolization in the course of hepatocellular carcinoma (HCC) performed with microspheres loaded with doxorubicin [9]. The aim of the present study is to assess the relationship between the administration site of irinotecan microspheres (the branch level of embolization) and the subsequent presence of complications and the severity of postembolization syndrome (PES) in the treatment of liver metastatic lesions from colorectal cancer. ...
Purpose:
Transarterial chemoembolization with drug eluting beads (DEB-TACE) loaded with irinotecan despite having proven efficacy in the treatment of unresectable liver metastases in the course of colorectal cancer (CRC) does not have an established consistent method. In particular, there are discrepancies in the branch level at which microspheres are administered. Lobar embolization supplies microspheres to all vessels supplying a metastatic lesion but exposes the entire liver parenchyma to negative effects from microsphere irinotecan. Superselective chemoembolization compromises healthy liver parenchyma less but may omit small vessels supplying metastatic lesions.
Objective:
Assessment of the risk of complications and the severity of postembolization syndromes with CRC metastatic liver lesion chemoembolization with irinotecan-loaded microspheres, according to branch level of chemoembolization.
Patients and methods:
The analysis included 49 patients (27 female/22 male) with liver metastases in the course of CRC, who underwent 192 chemoembolization treatments (mean 3.62 per patient) with microspheres loaded with 100 mg irinotecan. The procedures were performed according to an adopted schema: alternating the right and left lobe of the liver at 3-week intervals. The severity of postembolization syndrome (PES) and the presence of complications were assessed according to the branch level of chemoembolization; microspheres were administered at the branch level of lobar, segmental, or subsegmental arteries. Assessment of adverse events was performed according to the standards of the Cancer Therapy Evaluation Program Common Terminology Criteria for Adverse Events, Version 5.0.
Results:
The median survival of all patients from the start of chemoembolization was 13 months. With 192 chemoembolization sessions, 14 (7.3%) serious complications were found. The study showed no significant relationship between the branch level of embolizate administration and the presence of complications (p = 0.2307). Postembolization syndrome was diagnosed after 102 chemoembolization treatments, i.e., 53.1% of treatments. A significant correlation was found between the severity of the postembolization syndrome and the branch level of embolization treatment (p = 0.00303). The mean PES severity increased from subsegmental through segmental to lobar administration.
Conclusion:
Chemoembolization using Irinotecan-loaded microspheres was relatively well tolerated by patients and gave a low risk of significant complications, which did not change with the branch level of microsphere administration. However, an association was found between the branch level of chemoembolization and the severity of postembolization syndrome. Further research is needed to determine the most effective DEB-TACE chemoembolization technique.
... Adverse events after TACE mainly include elements of the post-embolization syndrome (PES), which may occur after up to 87% of procedures [9]. This syndrome has various definitions in the literature but can include abdominal pain, nausea, vomiting, fever, and fatigue. ...
... This syndrome has various definitions in the literature but can include abdominal pain, nausea, vomiting, fever, and fatigue. Studies evaluating the risk factors of PES suggest that it is more frequent when patients are treated with conventional TACE (cTACE) than with drug-eluting bead TACE (DEB-TACE), when the cystic artery is embolized as well as with a higher dose of treatment and that its incidence is lower in subsequent TACE sessions and with selective catheterization [9][10][11][12]. ...
Objectives
To prospectively assess the frequency of severe abdominal pain during and after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) using the visual analog scale (VAS), and to identify predictive factors.Methods
Ninety-eight TACE performed in 80 patients (mean 65 ± 12 years old, 60 men) were consecutively and prospectively included. Abdominal pain was considered severe if the VAS ≥ 30/100 after treatment administration, or if opioid analgesic (grades 2–3) intake was required during hospitalization. Patient and tumor characteristics as well as technical factors associated with severe pain were identified by binary logistic regression.ResultsThe criterion for severe pain was met in 41/98 (42%) of procedures (peri-procedural pain 30/98 [31%] and opioid consumption during hospitalization 24/98 [25%]). Multivariate analysis identified age (odds ratio [OR] = 0.943 (95% confidence interval 0.895–0.994), p = 0.029), cirrhosis (OR = 0.284 (0.083–0.971), p = 0.045), and alcoholic liver disease (OR = 0.081 (0.010–0.659), p = 0.019) as negative predictive factors of severe abdominal pain. Severe abdominal pain occurred in or after 1/13 (8%), 8/34 (24%), 22/41 (54%), and 10/10 (100%) TACE sessions when none, one, two, and three of the protective factors were absent, respectively (p < 0.001). The area under the ROC curve of the combination of factors for the prediction of severe abdominal pain was 0.779 (CI 0.687–0.871).Conclusion
Severe abdominal pain was frequent during and after TACE revealing a clinically relevant and underestimated problem. A predictive model based on three readily available clinical variables suggests that young patients without alcoholic liver disease or cirrhosis could benefit from reinforced analgesia.Key Points
• Severe abdominal pain occurs in 43% of TACE for HCC.
• Younger age, absence of cirrhosis, and absence of alcoholic liver disease were identified as independent predictive factors of severe abdominal pain.
• A simple combination of the three abovementioned features helped predict the occurrence of severe abdominal pain.
... PES is not considered a true adverse event but represents a reaction to treatment [36]. The rate of PES was as high as 47.7 % in cTACE and 24.7 % in the Precision V trial [4,32]. ...
Purpose
To assess the safety and tolerability of transarterial drug-eluting bead chemoembolisation (DEB-TACE) using tightly calibrated 100-µm microspheres in hepatocellular carcinoma (HCC).
Method
This multicentre prospective study included 131 patients with a 2-year follow-up. All patients had Child-Pugh scores ≤ B7, a good performance status, and Barcelona Clinic Liver Cancer stage A or B. Beads were loaded with 50 mg of doxorubicin per millilitre. Overall, 223 nodules were treated (mean size: 27.6 mm, average number of nodules per patient: 1.7). Toxicity was assessed using Common Terminology Criteria for Adverse Events 4.03 and response according to the modified Response Evaluation Criteria in Solid Tumours. The primary endpoint was safety. Secondary endpoints included technical success, post-embolisation syndrome (PES), local tumour response, and 2-year survival.
Results
A total of 214 DEB-TACE procedures were performed (mean per patient: 1.64), with a technical success rate of 97.6% and a PES rate of 9.3%. Major complications occurred in 6.8% of patients and 4.1% of procedures. There were no treatment-related deaths. Doxorubicin dose was an independent predictor of complications (p = 0.01). Four patients were lost to follow-up and 18 received liver transplants. Objective response rates were 74.6%, 45.7%, and 44.1% at 6, 12, and 24 months, respectively. The cumulative 24-month overall survival rate was 55.96%. Median survival was 22 months (interquartile range = 13-24). Co-morbidities and tumour response were independent predictors of survival (p = 0.0012 and 0.0052, respectively). Complications did not affect survival (p = 0.24).
Conclusions
DEB-TACE with tightly calibrated 100-µm beads is safe and not associated with increases in biliary toxicity or complications. Tumour response and survival are in the expected range for chemoembolisation therapy. (Clinical trials ID: NCT02670122)
