TY - JOUR
T1 - Liver/biliary injuries following chemoembolisation of endocrine tumours and hepatocellular carcinoma
T2 - Lipiodol vs. drug-eluting beads
AU - Guiu, Boris
AU - Deschamps, Frédéric
AU - Aho, Serge
AU - Munck, Flore
AU - Dromain, Clarisse
AU - Boige, Valérie
AU - Malka, David
AU - Leboulleux, Sophie
AU - Ducreux, Michel
AU - Schlumberger, Martin
AU - Baudin, Eric
AU - De Baere, Thierry
PY - 2012/3
Y1 - 2012/3
N2 - Background & Aims: 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.
AB - Background & Aims: 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.
KW - Biloma
KW - Iodised oil
KW - Liver cancer
KW - Liver infarct
KW - Neuroendocrine tumour
UR - http://www.scopus.com/inward/record.url?scp=84857362320&partnerID=8YFLogxK
U2 - 10.1016/j.jhep.2011.09.012
DO - 10.1016/j.jhep.2011.09.012
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C2 - 22027582
AN - SCOPUS:84857362320
SN - 0168-8278
VL - 56
SP - 609
EP - 617
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 3
ER -