Transarterial embolization for hepatocellular carcinoma. Antibiotic prophylaxis and clinical meaning of postembolization fever

Castells, Antoni; Bruix, Jordi; Ayuso, Carmen; Bru, C.; Montanyà, Xavier; Boix, Loreto; Rodés, Joan

doi:10.1016/0168-8278(95)80103-0

Cited by 93 publications

(75 citation statements)

References 26 publications

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“…The syndrome is characterised by a swinging fever, right upper quadrant pain, elevation of the hepatic transaminase enzymes, aspartate amino transferase, alanine amino transferase and gamma glutamyl transferase. The significance of this syndrome is uncertain, but has been considered by some to represent tumour necrosis and a successful response to chemoembolisation (Hwang et al, 1987;Bismuth et al, 1992; Groupe d'Etude de la traitment du Carcinome Hepatocellulaire, 1995;Castells et al, 1995;Takenaka et al, 1995). This assertion has been brought into question by a recent study in which the livers of patients who had undergone TACE prior to surgical resection of primary hepatocellular carcinoma were examined (Paye et al, 1999).…”

mentioning

confidence: 85%

Postchemoembolisation syndrome – tumour necrosis or hepatocyte injury?

et al. 2003

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Transarterial chemoembolisation of liver tumours is typically followed by elevated body temperature and liver transaminase enzymes. This has often been considered to indicate successful embolisation. The present study questions whether this syndrome reflects damage to tumour cells or to the normal hepatic tissue. The responses to 256 embolisations undertaken in 145 patients subdivided into those with hepatocyte-derived (primary hepatocellular carcinoma) and nonhepatocyte-derived tumours (secondary metastases) were analysed to assess the relative effects of tumour necrosis and damage to normal hepatocytes in each group. Cytolysis, measured by elevated alanine aminotransferase, was detected in 85% of patients, and there was no difference in the abnormalities in liver function tests measured between the two groups. Furthermore, cytolysis was associated with a higher rate of postprocedure symptoms and side effects, and elevated temperature was associated with a worse survival on univariate analysis. Multivariate analysis demonstrated that there was no benefit in terms of survival from having elevated temperature or cytolysis following embolisation. Cytolysis after chemoembolisation is probably due to damage to normal hepatocytes. Temperature changes may reflect tumour necrosis or necrosis of the healthy tissue. There is no evidence that either a postchemoembolisation fever or cytolysis is associated with an enhanced tumour response or improved long-term survival in patients with primary or secondary liver cancer.

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confidence: 85%

Postchemoembolisation syndrome – tumour necrosis or hepatocyte injury?

et al. 2003

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“…Fasting is required for 24 hours and IV hydration is mandatory. Prophylactic antibiotics are not routinely used 316 Fever is a reflection of tumor necrosis, but a minority of patients may develop severe infectious complications such as hepatic abscess or cholecystitis. The post-embolization syndrome is usually self-limited in less than 48 hours and the patients can be discharged from the hospital.…”

Section: Transarterial Embolization and Chemoembolizationmentioning

confidence: 99%

Management of Hepatocellular Carcinoma *

2005

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“…Este fenómeno, inicialmente considerado como complicación del procedimiento, ocurre en aproximadamente un tercio de los casos. Se ha reportado como factor de buen pronóstico en relación a la respuesta, ya que se relaciona directamente con la extensión de la necrosis tumoral 16 .…”

Section: Discussionunclassified