A prospective study regarding the complications of transcatheter intraarterial lipiodol chemoembolization in patients with hepatocellular carcinoma.
BACKGROUND
Hepatocellular carcinoma (HCC) is a common cause of cancer death throughout the world. The majority of patients are not suitable for curative resection either because of the advanced stage of the disease at the time of presentation or because of underlying cirrhosis. Transcatheter intraarterial lipiodol chemoembolization (TACE) has been reported to be one of the most effective palliative measures for HCC. However, its severe side effects continue to make its use controversial.


METHODS
In the current study, the authors prospectively evaluated 197 sessions of TACE performed in 59 patients with HCC.


RESULTS
Acute hepatic decompensation occurred in 20% of the 197 sessions with 3% of cases being irreversible. Significant elevation of bilirubin was associated with the dosage of cisplatin used (P = 0.0001), basal bilirubin level (P = 0.0001), basal prothrombin time (P =0.004), basal aspartate aminotransferase (AST) level (P = 0.013), and stage of cirrhosis (P < 0.0001). Patients with irreversible hepatic decompensation were more likely to have higher pre-TACE bilirubin levels (P = 0.009), more prolonged prothrombin time (P = 0.015), received a higher dose of cisplatin (P = 0.033), and more advanced cirrhosis (P < 0.0001). The majority of the other side effects were self-limiting with the exception of one patient who died of liver and splenic abscesses. Approximately 36% of the patients achieved a tumor response, 39% achieved stable disease, and 29% developed progressive disease.


CONCLUSIONS
The results of the current study identified factors that appeared to predispose patients to irreversible hepatic decompensation after TACE. Despite the high percentage of patients who developed hepatic decompensation after TACE, irreversible damage occurred in only a minority.
Chan
Annie O
AO
Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong.
Yuen
Man-Fung
MF
Hui
Chee-Kin
CK
Tso
Wai-Kuen
WK
Lai
Ching-Lung
CL
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D002404:Catheterization; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D003287:Contrast Media / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D007459:Iodized Oil / Q000008:administration & dosage / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000209:etiology; D008107:Liver Diseases / Q000209:etiology*; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D012307:Risk Factors
D003287:Contrast Media; D007459:Iodized Oil