4:21 PM Abstract No. 331 Quantitative analysis of Lipiodol washout rates in intrahepatic cholangiocarcinoma and hepatic metastasis from neuroendocrine tumors and colorectal cancer after chemoembolization

Abstract

Purpose: To compare the analgesic and antiemetic requirements after transarterial chemoembolization with doxorubicin eluting microspheres (DEB-TACE) versus conventional chemoembolization (cTACE) in patients with hepatocellular carcinoma (HCC). Materials: Between 2014-2016, 283 patients (mean age 66 y, 72% male) underwent 395 super-selective TACE procedures (189 cTACE, 206 DEB-TACE) for HCC within UCSF criteria. cTACE was performed using 5 mg/mL doxorubicin emulsified with ethiiodized oil for a maximum dose of 50 mg and DEB-TACE was performed with100-300 m spheres impregnated with 150 mg of doxorubicin (LC beads, BTG, UK). Patients were retrospectively reviewed for tumor characteristics, procedural technique, prior therapies and chronic pain. Postoperative (within 6 h post-TACE) and overnight use of intravenous and oral analgesics and antiemetic agents was assessed. Results: Baseline demographics, Child-Pugh scores, prior therapies and chronic pain history were similar between both groups. Median tumor diameter for cTACE was 2.2 cm (mean 2.5 cm, SD 1.2 cm) and was 2.4 cm for DEB-TACE (mean 2.9 cm, SD 1.4 cm). Delivered doxorubicin dose was higher with DEB-TACE than with cTACE (55.2 mg vs 29.6 mg, p<0.0001). While the need for intravenous analgesia and antiemetic agents was similar for both groups in the postoperative period (p ¼ 0.3), a higher percentage of patients treated with DEB-TACE required overnight intravenous analgesia and antiemetics (23% vs. 11% cTACE, p ¼ 0.002), increasing the overall utilization of intravenous drugs in the DEB-TACE group (p ¼ 0.04). Requirements for oral narcotic analgesia were also higher following DEB-TACE compared to cTACE (56% vs. 43%, p ¼ 0.01). Delivered doxorubicin dose and nausea were correlated (p ¼ 0.016) and thus resulted in increased requirements for antiemetic agents following DEB-TACE (25% vs 16% for cTACE, p ¼ 0.04). Conclusions: Patients undergoing DEB-TACE require more post procedural analgesia and antiemetic agents compared to cTACE. Postprocedural care should be planned accordingly to ensure patient comfort especially when considering same-day discharge.