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Zandieh G, Yazdaninia I, Afyouni S, Shaghaghi M, Borhani A, Mohseni A, Shaghaghi S, Liddell R, Kamel IR. Spectrum of Imaging Findings and Complications After Hepatic Transarterial Chemoembolization for Liver Tumors. J Comput Assist Tomogr 2024:00004728-990000000-00305. [PMID: 38595176 DOI: 10.1097/rct.0000000000001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
ABSTRACT This study reviews the spectrum of imaging findings and complications after transarterial chemoembolization (TACE) for the treatment of primary liver tumors (hepatocellular carcinoma, cholangiocarcinoma) and liver metastases. The review encompasses a spectrum of imaging criteria for assessing treatment response, including the modified Response Evaluation Criteria in Solid Tumors guidelines, tumor enhancement, and apparent diffusion coefficient alterations.We discuss the expected posttreatment changes and imaging responses to TACE, describing favorable and poor responses. Moreover, we present cases that demonstrate potential complications post-TACE, including biloma formation, acute cholecystitis, abscesses, duodenal perforation, arterial injury, and nontarget embolization. Each complication is described in detail, considering its causes, risk factors, clinical presentation, and imaging characteristics.To illustrate these findings, a series of clinical cases is presented, featuring diverse imaging modalities including computed tomography, magnetic resonance imaging, and digital subtraction angiography.
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Affiliation(s)
- Ghazal Zandieh
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Iman Yazdaninia
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Shadi Afyouni
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Mohamadreza Shaghaghi
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Ali Borhani
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Alireza Mohseni
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Shiva Shaghaghi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Robert Liddell
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD
| | - Ihab R Kamel
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
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Kacała A, Dorochowicz M, Korbecki A, Sobański M, Puła M, Patrzałek D, Janczak D, Guziński M. Transarterial Bleomycin-Lipiodol Chemoembolization for the Treatment of Giant Hepatic Hemangiomas: An Assessment of Effectiveness. Cancers (Basel) 2024; 16:380. [PMID: 38254869 PMCID: PMC10814004 DOI: 10.3390/cancers16020380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
This study evaluates the effectiveness of superselective transcatheter arterial chemoembolization (TACE) using a bleomycin-lipiodol emulsion in treating giant hepatic hemangiomas. A retrospective review included 31 patients with a mean age of 53 ± 10.42 years who underwent TACE from December 2014 to October 2022, with follow-up imaging examinations to assess outcomes. Technical success was defined as successful embolization of all feeding arteries, and clinical success was defined as a reduction in hemangioma volume by 50% or more on follow-up imaging. This study observed a 100% technical success rate. Post-embolization syndrome was common, and two cases of asymptomatic hepatic artery dissection were noted. Clinical success was achieved in 80.6% of patients, with significant volume reduction observed in the majority. Conclusively, superselective transcatheter arterial chemoembolization with bleomycin-lipiodol emulsions is presented as a viable and effective treatment option for giant hepatic hemangiomas. With no procedure-related mortality and significant volume reduction in most cases, this method offers a promising alternative to surgical intervention. This study's findings suggest a need for further exploration and validation in larger-scale prospective studies.
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Affiliation(s)
- Arkadiusz Kacała
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | | | - Adrian Korbecki
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (A.K.); (M.P.)
| | - Michał Sobański
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (A.K.); (M.P.)
| | - Michał Puła
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (A.K.); (M.P.)
| | - Dariusz Patrzałek
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Maciej Guziński
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
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Kacała A, Dorochowicz M, Patrzałek D, Janczak D, Guziński M. Safety and Feasibility of Transarterial Bleomycin-Lipiodol Embolization in Patients with Giant Hepatic Hemangiomas. Medicina (Kaunas) 2023; 59:1358. [PMID: 37629648 PMCID: PMC10456525 DOI: 10.3390/medicina59081358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023]
Abstract
Giant hepatic hemangiomas present a significant clinical challenge, and effective treatment options are warranted. This study aimed to assess the safety and feasibility of transarterial bleomycin-lipiodol embolization in patients with giant hepatic hemangiomas. A retrospective analysis was conducted on patients with giant hepatic hemangiomas (>5 cm). Transarterial chemoembolization (TACE) was performed using 7-20 cc of lipiodol mixed with 1500 IU of bleomycin. Safety outcomes, including post-embolization syndrome (PES), hepatic artery dissection, systemic complications, and access site complications, were evaluated. Radiation doses were also measured. Feasibility was assessed based on the achieved hemangioma coverage. Seventy-three patients (49 female, 24 male) with a mean age of 55.52 years were treated between December 2014 and April 2023. The average hospitalization duration was 3.82 days, and 97.3% of lesions were limited to one liver lobe. The average bleomycin dose per procedure was 1301.5625 IU, while the average lipiodol dose was 11.04 cc. The average radiation dose was 0.56 Gy. PES occurred after 45.7% of TACE procedures, with varying severity. Complications such as hepatic artery dissection (three cases), access site complications (two cases), and other complications (one case) were observed. No treatment-related mortality occurred. Hemangioma coverage exceeding 75% was achieved in 77.5% of cases. The study results suggest that transarterial bleomycin-lipiodol embolization is a safe and feasible treatment option for a heterogeneous group of patients with giant hepatic hemangiomas. This approach may hold promise in improving outcomes for patients with this challenging condition.
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Affiliation(s)
- Arkadiusz Kacała
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Mateusz Dorochowicz
- Faculty of Medicine, Wroclaw Medical University, Wybrzeże L. Pasteura 1, 50-367 Wroclaw, Poland
| | - Dariusz Patrzałek
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Maciej Guziński
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
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Guan Y, Tian Y, Fan YW. Pain management in patients with hepatocellular carcinoma after transcatheter arterial chemoembolisation: A retrospective study. World J Gastrointest Surg 2023; 15:374-386. [PMID: 37032798 PMCID: PMC10080608 DOI: 10.4240/wjgs.v15.i3.374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/11/2023] [Accepted: 02/15/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Pain after transcatheter arterial chemoembolisation (TACE) can seriously affect the prognosis of patients and the insertion of additional medical resources.
AIM To develop an early warning model for predicting pain after TACE to enable the implementation of preventive analgesic measures.
METHODS We retrospectively collected the clinical data of 857 patients (from January 2016 to January 2020) and prospectively enrolled 368 patients (from February 2020 to October 2022; as verification cohort) with hepatocellular carcinoma (HCC) who received TACE in the Hepatic Surgery Center of Tongji Hospital. Five predictive models were established using machine learning algorithms, namely, random forest model (RFM), support vector machine model, artificial neural network model, naive Bayes model and decision tree model. The efficacy of these models in predicting postoperative pain was evaluated through receiver operating characteristic curve analysis, decision curve analysis and clinical impact curve analysis.
RESULTS A total of 24 candidate variables were included in the predictive models using the iterative algorithms. Age, preoperative pain, number of embolised tumours, distance from the liver capsule, dosage of iodised oil and preoperative prothrombin activity were closely associated with postoperative pain. The accuracy of the predictive model was compared between the training [area under the curve (AUC) = 0.798; 95% confidence interval (CI): 0.745-0.851] and verification (AUC = 0.871; 95%CI: 0.818-0.924) cohorts, with RFM having the best predictive efficiency (training cohort: AUC = 0.869, 95%CI: 0.816-0.922; internal verification cohort: AUC = 0.871; 95%CI: 0.818-0.924).
CONCLUSION The five predictive models based on advanced machine learning algorithms, especially RFM, can accurately predict the risk of pain after TACE in patients with HCC. RFM can be used to assess the risk of pain for facilitating preventive treatment and improving the prognosis.
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Affiliation(s)
- Yan Guan
- Hepatic Surgery Center, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Ye Tian
- Hepatic Surgery Center, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Ya-Wei Fan
- Hepatic Surgery Center, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Liu YS, Lin XZ, Chen CY, Chiu YC, Kang JW, Tsai HW, Hung HY, Ho CM, Ou MC. Safety and effectiveness of new embolization microspheres SCBRM for intermediate-stage hepatocellular carcinoma: A feasibility study. Bosn J Basic Med Sci 2021; 21:339-345. [PMID: 32841586 PMCID: PMC8112559 DOI: 10.17305/bjbms.2020.4770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/25/2020] [Indexed: 12/24/2022] Open
Abstract
Transarterial chemoembolization (TACE) is, currently, the recommended treatment for hepatocellular carcinoma (HCC). However, long-term chemoembolization triggers the inflammatory response and may lead to postembolization syndrome (PES). Although several types of degradable microspheres have been developed to reduce drug toxicity and PES incidence, the clinical outcomes remain unsatisfactory. Previously, we have developed a new type of spherical, calibrated, biodegradable, radiopaque microspheres (SCBRM) and demonstrated their safety and efficacy in a pig model. Thus, the goal of this feasibility study was to determine the clinical safety and efficacy of the new SCBRM in intermediate-stage HCC patients. In this study, 12 intermediate-stage HCC patients underwent TACE using SCBRM with a calibrated size of 100–250 μm. The disease control rates at 1 month and 3 months after TACE-SCBRM treatment were 100% and 75.0%, respectively. The objective response rates at 1 month and 3 months after treatment were 66.7% and 58.3%, respectively. Very few adverse events were observed with one patient developing nausea. One day after the treatment, alanine aminotransferase, alanine aminotransferase, and total bilirubin levels were slightly elevated in the patients, but all returned to baseline on day 7. The median and mean overall survival times were 33 months (interquartile range, 12.8–42.0) and 29.2 ± 14.3 months, respectively. The 1-year and 2-year survival rates were 91.7% and 58.3%, respectively. In conclusion, TACE with the new SCBRM microspheres is clinically safe and effective, and it represents a promising approach in the management of intermediate-stage HCC.
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Affiliation(s)
- Yi-Sheng Liu
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Xi-Zhang Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiung-Yu Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen-Cheng Chiu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jui-Wen Kang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hung-Wen Tsai
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Yu Hung
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Ming Ho
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Ching Ou
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Blackburn H, West S. Management of Postembolization Syndrome Following Hepatic Transarterial Chemoembolization for Primary or Metastatic Liver Cancer. Cancer Nurs. 2016;39:E1-E18. [PMID: 26484962 DOI: 10.1097/ncc.0000000000000302] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Transarterial chemoembolization (TACE) is an established treatment in managing liver primary neoplasms or liver metastases. Postembolization syndrome (PES) is a common adverse event defined as fever without associated sepsis, pain in the right upper quadrant, and nausea and/or vomiting. OBJECTIVE This integrative review aims to identify effective management strategies for PES or one of its characterizing symptoms (fever, pain, and nausea and/or vomiting). METHODS Searches of electronic databases MEDLINE, EMBASE, and CINAHL were conducted. Fifteen articles were identified for inclusion. Seven addressed all symptoms of PES, and 8 studies focused on individual symptoms of PES. RESULTS Interventions identified are intra-arterial lidocaine, oral and intravenous analgesics, steroids, wrist-ankle acupuncture, antibiotics, and 5-HT3 receptor antagonists. Findings are explicated according to individual symptoms of PES. Intra-arterial lidocaine, steroids, and a 5-HT3 receptor antagonist are found to offer potential benefit in the management of PES symptoms. CONCLUSION A number of interventions have shown potential benefit in the management of PES. A systemic approach using combination therapy is necessary to effectively manage characterizing symptoms. Further research is needed to determine the impact of primary disease site, TACE technique, and chemotherapeutic agent on PES. IMPLICATIONS FOR PRACTICE Oncology nurses are uniquely placed to undertake thorough patient assessment after TACE and implement early intervention to effectively manage PES.
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Shun SC, Chen CH, Sheu JC, Liang JD, Yang JC, Lai YH. Quality of life and its associated factors in patients with hepatocellular carcinoma receiving one course of transarterial chemoembolization treatment: a longitudinal study. Oncologist 2012; 17:732-9. [PMID: 22511265 DOI: 10.1634/theoncologist.2011-0368] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To (a) explore changes in physical and psychological distress and quality of life (QOL) and (b) identify the significant pre- and postdischarge factors related to changes in physical and mental domains of QOL over a period of 2 months in patients with hepatocellular carcinoma receiving one course of transarterial chemoembolization (TACE) treatment. METHODS A longitudinal prospective design was used, with participants recruited from a teaching hospital in Northern Taiwan. Data were collected three times: within 3 days prior to discharge (T0) and at the fourth (T1) and eighth (T2) weeks after discharge. A set of structured questionnaires was used to assess participants' QOL, symptom distress, anxiety, and depression. Changes in QOL and associated factors were examined using generalized estimating equations. RESULTS Eighty-nine patients were included in this study. Fatigue was reported to be the most distressful symptom after treatment. Overall QOL improved monthly after discharge. Change in physical QOL 2 months after TACE treatment was associated with age, diagnosis status, level of symptom distress, and depression after discharge. Change in mental QOL was significantly associated with gender, diagnosis status, and anxiety and depression after discharge. CONCLUSIONS Health care providers should pay special attention to patients of older age, those who are male, and those who have higher levels of depression and anxiety after discharge. Designing personalized education programs before discharge for patients with newly diagnosed cancer versus those who have recurrent disease is suggested to help patients maintain a better QOL after discharge.
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Affiliation(s)
- Shiow-Ching Shun
- Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
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