Transarterial Chemoembolization for Primary Hepatocellular Carcinoma in Patients at High Risk

Kothary, Nishita; Weintraub, Joshua; Susman, Jonathan; Rundback, John H.

doi:10.1016/j.jvir.2007.07.035

Cited by 88 publications

(58 citation statements)

References 65 publications

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“…Among high-risk patients, selective or superselective TACE has been associated with procedure-related morbidity rates ranging from 2% to 10.8% and 30-day mortality rates ranging from 1% to 7.7%. [16][17][18] In these studies, the definitions of highrisk features were based on a number of laboratory, radiographic, or clinical parameters, which varied widely. Kothary et al 18 in 2007 reported complication outcomes for 52 patients undergoing 65 TACE procedures.…”

Section: Survival Analysismentioning

confidence: 99%

“…[16][17][18] In these studies, the definitions of highrisk features were based on a number of laboratory, radiographic, or clinical parameters, which varied widely. Kothary et al 18 in 2007 reported complication outcomes for 52 patients undergoing 65 TACE procedures. In this study, high-risk subjects demonstrated at least one of the following features: a bilirubin level > 2 mg/dL, an albumin level < 3.5 mg/dL, a CTP score > 9, multifocal disease, a TIPS, or a biliary obstruction.…”

Section: Survival Analysismentioning

confidence: 99%

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Morbidity and mortality following transarterial liver chemoembolization in patients with hepatocellular carcinoma and synthetic hepatic dysfunction

et al. 2012

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The purpose of this study was to determine the rate and risk factors for the development of irreversible hepatotoxicity after transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) and synthetic hepatic dysfunction. Two hundred fifty-one consecutive patients with HCC and hepatic dysfunction who underwent 443 TACE procedures from 2005 to 2010 were retrospectively reviewed. The included patients met one of the following criteria: a pre-TACE bilirubin level 2 mg/dL, an international normalized ratio (INR) > 1.5, a creatinine level > 1.2 mg/dL, a platelet count 60,000/ mL, a Model for End-Stage Liver Disease (MELD) score > 15, Child-Turcotte-Pugh class B or C, ascites, or portal vein thrombosis. Hepatotoxicity was defined as new or worsening ascites, encephalopathy, or grade 3 or 4 toxicity (bilirubin, aspartate aminotransferase, alanine aminotransferase, creatinine, or INR) according to the National Cancer Institute Common Terminology Criteria for Adverse Events. The rate and risk factors for death or urgent liver transplantation within 6 weeks of TACE and irreversible hepatotoxicity were determined with a generalized estimating equation analysis. Reversible hepatotoxicity developed after 90 procedures (20%) in 78 patients (31%). Irreversible hepatotoxicity developed after 41 procedures (9%) in 37 patients (15%). Six patients (2%) underwent urgent liver transplantation, and 11 (4%) died within 6 weeks of TACE. Patients at increased risk for procedure-related mortality or urgent liver transplantation within 6 weeks of TACE had a baseline serum bilirubin level 4.0 mg/dL (P ¼ 0.01), an elevated INR (P < 0.001), hypoalbuminemia with an albumin level < 2.0 g/L (P ¼ 0.01), a serum creatinine level > 2.0 mg/dL (P ¼ 0.02), large ascites (P ¼ 0.002), encephalopathy (P ¼ 0.005), or a MELD score 20 (P < 0.001). In conclusion, TACE can be performed safely in patients with baseline hepatic dysfunction. However, a poor hepatic reserve increases the risk of irreversible hepatotoxicity, which may lead to death or the need for urgent liver transplantation. Transarterial chemoembolization (TACE) is a standard treatment option for patients with unresectable, intermediate-stage hepatocellular carcinoma (HCC) without significant hepatic synthetic dysfunction.1 TACE produces an objective tumor response rate of 35% to 40% and confers a significant survival advantage in

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Section: Survival Analysismentioning

confidence: 99%

Section: Survival Analysismentioning

confidence: 99%

Morbidity and mortality following transarterial liver chemoembolization in patients with hepatocellular carcinoma and synthetic hepatic dysfunction

et al. 2012

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“…Liver-directed therapies are widely used to ''bridge'' patients to transplant or to treat patients with unresectable HCC (8). Transarterial chemoembolization has become a commonly employed treatment for HCC (9)(10)(11). However, hepatic dysfunction is frequently observed after chemoembolization (12,13).…”

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confidence: 99%

Hepatotoxicity after Transarterial Chemoembolization and Transjugular Intrahepatic Portosystemic Shunt: Do Two Rights Make a Wrong?

Kohi

Fidelman

Naeger

et al. 2013

Journal of Vascular and Interventional Radiology

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Purpose: To compare the rates of hepatotoxicity after transarterial chemoembolization for hepatocellular carcinoma (HCC) in patients with and without a transjugular intrahepatic portosystemic shunt (TIPS) who were stratified into comparable risk groups. Materials and Methods:A retrospective review of patients with HCC who were treated with transarterial chemoembolization between January 2005 and December 2009 was performed. Of 158 patients with comparable model for end-stage liver disease (MELD) scores, 10 had a patent TIPS. Hepatobiliary severe adverse events (SAEs) occurring after transarterial chemoembolization were documented. In addition, 1-year survival and liver transplantation rate after transarterial chemoembolization were calculated in each group. Results:The incidence of hepatobiliary SAEs after transarterial chemoembolization was nearly two times higher in patients with a TIPS (70%) than in patients without a TIPS (36%; P ¼ .046). The liver transplantation rate 1 year after transarterial chemoembolization was 2.5 times higher in patients with a TIPS (80%) than in patients without a TIPS (32%; P ¼ .004). There was no significant difference in 1-year survival between the two groups after transarterial chemoembolization. Conclusions:Patients with HCC and a patent TIPS are more likely to develop significant hepatotoxicity after transarterial chemoembolization than comparable patients without a TIPS in place.

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“…Recently, Kothary et al [10] evaluated the safety and efficacy of TACE in patients at high risk. They reported that the factors that determined the outcome were the extent of embolisation and the extent of replacement of liver parenchyma by the tumour.…”

Section: Discussionmentioning

confidence: 99%

Use of the triaxial microcatheter method in super-selective transcatheter arterial chemoembolisation for hepatocellular carcinoma

Shimohira¹,

Ogino²,

Kawai³

et al. 2011

BJR

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Transarterial Chemoembolization for Primary Hepatocellular Carcinoma in Patients at High Risk

Cited by 88 publications

References 65 publications

Morbidity and mortality following transarterial liver chemoembolization in patients with hepatocellular carcinoma and synthetic hepatic dysfunction

Morbidity and mortality following transarterial liver chemoembolization in patients with hepatocellular carcinoma and synthetic hepatic dysfunction

Hepatotoxicity after Transarterial Chemoembolization and Transjugular Intrahepatic Portosystemic Shunt: Do Two Rights Make a Wrong?

Use of the triaxial microcatheter method in super-selective transcatheter arterial chemoembolisation for hepatocellular carcinoma

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