Liver abscess after drug-eluting bead chemoembolization in patients with metastatic hepatic tumors

Objective: To investigate the incidence and risk factors for liver abscess formation after treatment with drug-eluting bead chemoembolization (DEB-TACE) in patients with metastatic hepatic tumors (MHT). Methods: The current study is a retrospective analysis of the clinical data of 137 patients with metastatic hepatic tumors who received DEB-TACE treatment in our institute between June 2015 and September 2020. Patients were evaluated for the presence or absence of post-DEB-TACE liver abscess. Univariate and multivariate analyses were used to identify risk factors for liver abscess formation. Results: The incidence of liver abscess formation after the DEB-TACE procedure was 8.76% per patient and 5.53% per procedure. Univariate analysis showed that larger maximum tumor diameter (p = 0.004), Grade one artery occlusion (p < 0.001) and systemic chemotherapy within 3 months before the DEB-TACE procedure (p < 0.001) were all associated with liver abscess formation. However, only systemic chemotherapy within 3 months before the DEB-TACE procedure (OR 5.49; 95% CI 0.34–13.54; p < 0.001) was identified by multivariate analysis to be an independent risk factor. Conclusions: Tumor size, Grade one artery occlusion and recent systemic chemotherapy may all be associated with increased risk of liver abscess formation following DEB-TACE treatment in patients with metastatic hepatic tumors. Advances in knowledge: Identification of risk factors for liver abscess formation following DEB-TACE in patients with MHT. These findings suggest the need for caution and consideration of the aforementioned risk factors on the part of interventional radiologists when designing DEB-TACE strategies and performing post-procedure patient management.

Abstract 17500: A Crisis of the Heart

A 59 year old female with past medical history of metastatic neuroendocrine tumor without cardiac involvement was admitted for transarterial catheter embolization (TACE) procedure of liver lesions. During the TACE procedure, she developed hypertensive urgency treated with intravenous beta blocker therapy and continuous octreotide for carcinoid reaction. The following day she developed acute pulmonary edema and labile blood pressures requiring low dose norepinephrine. Octreotide infusion was up-titrated to 500 mcg/hour with concern for carcinoid crisis. On physical exam, she was tachycardic and regular without notable murmurs or extra cardiac sounds, no elevated jugular venous distension, and no lower extremity edema. She had bilateral crackles on pulmonary exam and was diaphoretic and delirious. There were sub-millimeter lateral ST- segment elevations on her electrocardiogram but her troponin levels were elevated to 14 ng/dL. Point of care cardiac ultrasound demonstrated severely impaired left ventricular systolic function without regional wall motion abnormalities. Coronary angiogram revealed diffuse coronary vasospasm and elevated left ventricular end-diastolic pressure. On right heart catheterization, she had elevated filling pressures, pulmonary arterial oxygen saturation of 25%, and cardiac index of 1.42 L/min/m2. Our patient was diagnosed with cardiogenic shock secondary to octreotide mediated coronary vasospasm causing diffuse myocardial injury. Continued multidisciplinary discussions were needed to determine appropriate vasopressor and inotropic agent use to support cardiac function without triggering further hormonal dysregulation during carcinoid crisis. Her cardiac function eventually improved with left ventricular Impella support and gradual down-titration of octreotide dose. Norepinephrine, epinephrine, and phenylephrine were avoided in favor of vasopressin, and dobutamine was switched to milrinone to prevent further sympathetic activation. She was able to wean off Impella and pressor support and had improvement of her left ventricular function on repeat echocardiography one month later. She has not had recurrence of heart failure symptoms and continues to follow up with oncology via tele-visits.

Survival Benefit of Transarterial Chemoembolization for Hepatocellular Carcinoma

Objective: Transarterial chemo-embolization (TACE) is a palliative treatment option for hepatocellular carcinoma (HCC) with improved patient survival. The aim of the study was to see the outcome of our patients at our institution 2 years post TACE. Patients and Methods: Electronic records were retrospectively reviewed for patients who had TACE from 1st November 2009 – 31st October 2012. Baseline imaging, multidisciplinary team (MDT) and clinical notes, pathology labs, TACE angiograms and follow up imaging were reviewed for 2 years after first TACE. Procedure complications, clinical status and findings at follow up CT were reviewed and analyzed in SPSS version 19. Survival was assessed using Kaplan Meier curves. Results: A total of 104 patients had TACE for HCC. Amongst these 21 patients were lost to follow up and could not be contacted to reconfirm the outcome and had to be excluded to minimize bias. Amongst the included 83 patients, 57 (68.7%) were male and 65 (78.4%) were 51-70 years of age at time of first TACE. The commonest cause for HCC was HCV in 74 (89.2%) patients. Target lesion size at baseline CT was < 5 cm in 38 (45.8%) patients, 5-10 cm in 37 (44.6%) patients and >10 cm in 8 (9.6%) patients. A total of 25 (30%) patients needed more than 1 session of TACE. On post TACE CT, 46 (55.4%) patients had good packing of lipoidol in the lesion. A total of 18 (21.7%) patients progressed in TACED lesions while another 21 (25%) progressed with new lesions. One patient had metastasis to adrenal gland. Only 8 (9.6%) patients had liver failure after TACE and 1 patient had hepatorenal syndrome. Only 1 patient died within 30 days after TACE. Two years post TACE, 47 (56.6%) patients were alive indicating good outcome. Conclusion: TACE improves survival in HCC; 1 year survival was 80% and 2 year survival was 56.6%.

Hepatic Function during Repeated TACE Procedures and Prognosis after Introducing Sorafenib in Patients with Unresectable Hepatocellular Carcinoma: Multicenter Analysis

Background/Aim: We evaluated the relationship of hepatic function with repeated transarterial catheter chemoembolization (TACE) and prognosis after sorafenib treatment in various patient cohorts. Methods: Study 1 comprised of 212 Barcelona clinic liver cancer stage-B (BCLC-B) HCC patients classified as Child-Pugh A (CP-A) and who had received repeated TACE treatments (r-TACE) (naïve:recurrence = 66:146). Study 2 comprised of 435 patients with unresectable HCC classified as CP-A in who sorafenib was introduced (naïve:recurrence = 37:398; CP score 5:6 = 282:153; macro-vessel invasion [MVI]+: extrahepatic metastasis [EHM]+ both negative = 124:226:143). Changes in hepatic function along with CP and albumin-bilirubin (ALBI) score/grade during r-TACE in Study 1, and prognosis after introducing sorafenib in Study 2 were evaluated. Results: Hepatic function worsened to CP-B in 9-14% with each TACE procedure, while 18-21% had a change of classification from ALBI-1 to ALBI-2. When the prognosis of patients with the best CP score of 5 was analyzed, those with ALBI-1 (n = 154) had a better outcome than those with ALBI-2 (n = 128) (MST 17.5 vs. 9.9 months; p = 0.01), while ALBI-1 (n = 43) patients also showed a better outcome than ALBI-2 (n = 34) patients with a CP score of 5 without MVI/EHM (MST: 17.5 vs. 10.0 months; p = 0.029). The Akaike's Information criterion for ALBI-grade (MST: grade 1 vs. 2 = 16.9 vs. 10.4 months; p = 0.001) was also better than that for CP (MST: score 5 vs. 6 = 14.4 vs. 10.5 months; p = 0.003) (3195.6 vs. 3197.5) in all 435 patients. Conclusion: The rate of patients with downgraded hepatic function during r-TACE, especially with regard to ALBI-grade, was not low. ALBI-grade was shown to be a better hepatic function assessment tool than CP in patients receiving sorafenib treatment. Strict judgment of TACE-refractory status in patients with unresectable HCC is needed to improve prognosis before downgrading the hepatic function.

Transarterial Chemoembolization With Doxorubicineluting Microspheres: Single-Center Review Of Safety Profile

Background. Since 1977 when TACE was introduced for the first time it became a standard treatment for nonresectable HCC without vascular invasion or extrahepatic disease. TACE is also performed for other indications, such as colorectal metastases, cholangiocarcinoma, neuroendocrine tumors and etc. Material/methods. the evaluation of interventional therapy with DEB-TACE of 8 patients each with unrespectable HCC, cholangiocarcinoma, neuroendocrine metastatic carcinoma. A comparison of therapy- associated complications performed. Results. We analyzed results of DEB-TACE performed in our Hospital since 2014. DEB-TACE was technically successful in all patients. A total of 21 DEB-TACE procedure was performed in 8 patients during the 2-year period. Two patients (20%) had five treatments, 1 patient (15%) had four treatments, 4 patients (50%) had two treatments and 1 (15%) had one treatment. Pain, nausea, fever and fatigue were the most common side effects following DEBTACE, with a frequency of 76%, 33%, 57% and 71% respectively. Conclusions. The current results show DEB-TACE to produce beneficial tumor response and to have exceptionally low complication rates.