Post embolization syndrome in doxorubicin eluting chemoembolization with DC bead.
OBJECTIVE
The investigation of post embolization syndrome (PES) in patients with hepatocellular carcinoma (HCC) after treatment with doxorubicin loaded DC Bead (DEB-DOX).


METHODS
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, 48.9%) and B (n=121, 51%). Embolizations were as selective as possible with DC Bead of 100-300µm in diameter followed by 300-500µm loaded with doxorubicin at 37.5mg/mL of hydrated bead (max:150mg).


RESULTS
PES regardless of severity was observed in up to 86.5%. However grade 2 PES ranged between 25% and 42.19% across treatments. Temperatures above 38°C were seen in 22.7% to 38.3% across treatments. No statistically significant increase of PES was seen in beads of 100-300µm in diameter; incidence of fever and pain presented correlation with the extent of embolization (p=0.0001-0.006 across treatments). Baseline tumor diameter was associated with incidence of fever (p=0.0001-0.001). Duration of fever correlated with the extent of embolization (p=0.008). PES was not associated with elevation of liver enzymes and was correlated with degree of necrosis (p<0.001).


CONCLUSIONS
PES after DEB-DOX represents tumor response to treatment and does not represent collateral healthy liver damage.
Evgenidion University Hospital, Greece.
Maria
M
Pomoni
Katerina
K
Malagari
Hippokratis
H
Moschouris
Themistoklis N
TN
Spyridopoulos
Spyros
S
Dourakis
John
J
Kornezos
Alexios
A
Kelekis
Loukas
L
Thanos
Achilleas
A
Chatziioanou
Ioannis
I
Hatjimarkou
Athanasios
A
Marinis
John
J
Koskinas
Dimitrios
D
Kelekis
D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000175:diagnosis / Q000188:drug therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D003287:Contrast Media; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects*; D004337:Drug Carriers; D005221:Fatigue / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D006115:Greece; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000175:diagnosis / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D010316:Particle Size; D011446:Prospective Studies; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology
D000903:Antibiotics, Antineoplastic; D003287:Contrast Media; D004337:Drug Carriers; D004317:Doxorubicin