title: Liver and biliary damages following transarterial chemoembolization of hepatocellular carcinoma: comparison between drug-eluting beads and lipiodol emulsion.
abstract: OBJECTIVE
  To compare transarterial chemoembolization (TACE)-related hepatic toxicities of conventional TACE (cTACE) and drug-eluting beads TACE (DEB-TACE) in patients with intermediate-stage hepatocellular carcinoma.
  
  
  METHODS
  In this retrospective study, 151 consecutive patients undergoing cTACE or DEB-TACE and MRI 3-6 weeks before and after therapy were included. Toxicity was assessed on imaging (global hepatic damages (GHD), overall biliary injuries, biliary cast, bile duct dilatation, intrahepatic biloma, portal thrombosis), and clinico-biological follow-ups. Tumour response, time to progression (TTP), and overall survival were assessed. Factors influencing complication rate were identified by generalized equation logistic regression model.
  
  
  RESULTS
  Biliary injuries and intrahepatic biloma incidence were significantly higher following DEB-TACE (p < 0.001). DEB-TACE showed a significant increased risk of GHD (OR: 3.13 [1.74-5.63], p < 0.001) and biliary injuries (OR: 4.53 [2.37-8.67], p < 0.001). A significant relationship was found between baseline prothrombin value and GHD, biliary injuries and intrahepatic biloma (all p < 0.01), and between the dose of chemotherapy and intrahepatic biloma (p = 0.001). Only TTP was significantly shorter following DEB-TACE compared to cTACE (p = 0.025).
  
  
  CONCLUSIONS
  DEB-TACE was associated with increased hepatic toxicities compared to cTACE. GHD, biliary injuries, and intrahepatic biloma were more frequently observed with high baseline prothrombin value, suggesting that cTACE might be more appropriate than DEB-TACE in patients with less advanced cirrhosis.
  
  
  CONCLUSIONS
  • DEB-TACE demonstrated more therapy-related hepatic locoregional complications compared to cTACE. • TACE-related hepatic locoregional toxicities occurred more frequently with high baseline PT value. • cTACE may be more appropriate in patients with high baseline PT value.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Monier
authors.affiliation: Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland.|Department of Diagnostic and Interventional Radiology, Montpellier University Hospital, Montpellier, 34000, Avenue Emile Bertin Sans, France.
authors.forename: Boris
authors.initials: B
authors.lastname: Guiu
authors.affiliation: Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland.
authors.forename: Rafael
authors.initials: R
authors.lastname: Duran
authors.affiliation: Department of Epidemiology, University Hospital, Dijon, 21000, boulevard Jeanne d'Arc, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Aho
authors.affiliation: Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bize
authors.affiliation: Department of Gastroenterology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Deltenre
authors.affiliation: Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland.
authors.forename: Vincent
authors.initials: V
authors.lastname: Dunet
authors.affiliation: Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland. alban.denys@chuv.ch.
authors.forename: Alban
authors.initials: A
authors.lastname: Denys
mesh_terms: D000368:Aged; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D001652:Bile Ducts / Q000000981:diagnostic imaging / Q000503:physiopathology; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D004998:Ethiodized Oil / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000209:etiology; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D008113:Liver Neoplasms / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology
chemical_list: D004998:Ethiodized Oil
keywords: Chemoembolization; Hepatocellular carcinoma; Magnetic resonance imaging; TACE; Toxicity