Liver/biliary injuries following chemoembolisation of endocrine tumours and hepatocellular carcinoma: lipiodol vs. drug-eluting beads.
OBJECTIVE
Transarterial chemoembolisation (TACE) is usually performed by injecting an emulsion of a drug and iodised oil. Drug-eluting beads (DEBs) have undeniable pharmacological advantages by offering simultaneous embolisation and sustained release of the drug to the tumour. No data are currently available on liver/biliary injury following DEB-TACE. This study describes and compares liver/biliary injuries encountered with TACE in tumours developed in cirrhotic (hepatocellular carcinoma (HCC)) and non-cirrhotic (endocrine tumours (NETs)) livers.


METHODS
In consecutive patients treated for a well-differentiated metastatic NET (n=120) or a HCC (n=88), 684 CT- and MR-scans were analysed. Liver/biliary injuries were classified as follows: dilated bile duct, portal vein narrowing, portal venous thrombosis and biloma/liver infarct. A generalised estimating equation logistic regression model was used.


RESULTS
A liver/biliary injury followed 17.2% (82/476) of sessions in 30.8% (64/208) of patients. The occurrence of liver/biliary injury was associated with DEB-TACE (OR=6.63; p<0.001) irrespectively of the tumour type. Biloma/parenchymal infarct was strongly associated with both DEB-TACE (OR=9.78; p=0.002) and NETs (OR: 8.13; p=0.04). Biloma/liver infarcts were managed conservatively but were associated with an increase in serum levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatases, and gamma glutamyl transpeptidase (p=0.005, p=0.005, p=0.012, and p=0.006, respectively).


CONCLUSIONS
Liver/biliary injuries are independently associated with DEB-TACE. Biloma/liver infarct, the most serious injury, is independently associated with both DEB-TACE and NETs. The absence of such an association in TACE of HCC may be explained by the hypertrophied peribiliary plexus observed in cirrhosis, which protects against the ischemic/chemical insult of bile ducts. We suggest caution when using DEB-TACE in the non-cirrhotic liver.
Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, France. boris.guiu@chu-dijon.fr
Boris
B
Guiu
Frédéric
F
Deschamps
Serge
S
Aho
Flore
F
Munck
Clarisse
C
Dromain
Valérie
V
Boige
David
D
Malka
Sophie
S
Leboulleux
Michel
M
Ducreux
Martin
M
Schlumberger
Eric
E
Baudin
Thierry
T
de Baere
D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001660:Biliary Tract Diseases / Q000139:chemically induced*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D004998:Ethiodized Oil / Q000008:administration & dosage / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D007238:Infarction / Q000139:chemically induced; D008107:Liver Diseases / Q000209:etiology*; D008113:Liver Neoplasms / Q000188:drug therapy*; D016015:Logistic Models; D008863:Microspheres; D018358:Neuroendocrine Tumors / Q000188:drug therapy; D011169:Portal Vein; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000139:chemically induced
D000970:Antineoplastic Agents; D004998:Ethiodized Oil; D002945:Cisplatin