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Chemoembolization of hepatocellular carcinoma with drug-eluting beads complicated by interstitial pneumonitis.

ABSTRACT: Transarterial chemoembolization has proven benefit in the treatment of unresectable hepatocellular carcinoma (HCC). Commonly reported symptoms following chemoembolization with or without drug-eluting beads include abdominal pain, nausea, and low-grade fever, which typically limited resolve within a few days. A recent study comparing traditional chemoembolization versus chemoembolization with drug-eluting beads demonstrated similar survival between the two techniques, but improved tolerability when the drug-eluting beads were used. This case report describes a patient with unresectable HCC undergoing chemoembolization with drug-eluting beads. The postprocedure course was complicated by interstitial pneumonitis secondary to shunting of the drug-eluting beads containing doxorubicin to both lungs via tumor vasculature. This case highlights the relationship between the number and size of the tumors to be treated, arteriovenous shunting within the liver/tumors, and the size of the embolization particles.

SUBMITTER: Aladdin M

PROVIDER: S-EPMC3193323 | biostudies-other | 2011 Jun

REPOSITORIES: biostudies-other

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Project description:The purpose of this study was to investigate the efficacy and safety of drug-eluting beads transarterial chemoembolization (DEB-TACE) treatment in Chinese hepatocellular carcinoma (HCC) patients and the prognostic factors for treatment response as well as survival. A total of 275 HCC patients were included in this prospective study. Treatment response was assessed by modified Response Evaluation Criteria in Solid Tumors (mRECIST), and progression-free survival (PFS) as well as overall survival (OS) were determined. Liver function and adverse events (AEs) were assessed before and after DEB-TACE operation. Complete response (CR), partial response (PR), and objective response rate (ORR) were 22.9%, 60.7%, and 83.6%, respectively. The mean PFS was 362 (95% CI: 34.9-375) days, the 6-month PFS rate was 89.4?±?2.1%, while the mean OS was 380 (95% CI: 370-389) days, and the 6-month OS rate was 94.4?±?1.7%. Multivariate logistic regression revealed that portal vein invasion (p?=?0.011) was an independent predictor of worse clinical response. Portal vein invasion (p?=?0.040), previous cTACE treatment (p?=?0.030), as well as abnormal serum creatinine level (BCr) (p?=?0.017) were independent factors that predicted worse ORR. In terms of survival, higher Barcelona Clinic Liver Cancer (BCLC) stage (p?=?0.029) predicted for worse PFS, and abnormal albumin (ALB) (p?=?0.011) and total serum bilirubin (TBIL) (p?=?0.009) predicted for worse OS. The number of patients with abnormal albumin, total protein (TP), TBIL, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were augmented at 1 week posttreatment and were similar at 1-3 months compared with baseline. The most common AEs were pain, fever, nausea, and vomiting, and no severe AEs were observed in this study. DEB-TACE was effective and tolerable in treating Chinese HCC patients, and portal vein invasion, previous cTACE treatment, abnormal BCr, ALB, and TBIL appear to be important factors that predict worse clinical outcome.

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Chemoembolization of hepatocellular carcinoma with drug-eluting beads complicated by interstitial pneumonitis.

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