READ BEFORE ENTERING; This website is for information purposes only; we are not diagnosing, treating, curing, mitigating, or preventing any disease or medical condition by providing the information contained herein. Before beginning any natural, integrative or conventional treatment regimen, it is advisable to seek the advice of a licensed healthcare professional.

Complications of Chemoembolization

Complications of Chemoembolization – TACE (Transarterial Chemoembolization)

If you are here, you most likely know the basics of chemoembolization. Your doctor will not inform you of the adverse events and negative sides of this procedure, but we will. We believe that the failure to disclose imperative information about what can go wrong has taken away your right to informed consent, which is against the hypocritic oath. Did your doctor supply you with this information?

TACE is not recommended in cases of severe liver or kidney dysfunction, abnormal blood clotting, prior surgery or stenting of the bile duct, or a blockage of the bile ducts. In some cases—despite liver dysfunction—TACE may be done in small amounts and in several procedures to try and minimize the effect on the normal liver.  – But I bet a doctor would never do it on themselves if they had cirrhosis I bet. 

TACE is a treatment, not a cure. Approximately 70 percent of the patients will see improvement in the liver and, depending on the type of liver cancer, it may improve survival rates and quality of life. 

Potentially curative treatments for HCC include surgery (resection or transplant), radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI); approximately 30–40% of HCC patients globally who are diagnosed with very early (Stage 0) or early (Stage A) disease are eligible for these procedures 2, 9–11. For patients with intermediate-stage disease (Stage B), transarterial chemoembolization (TACE) is recommended to establish local control and palliation 3.

Patients with advanced HCC have limited treatment options, and chemotherapy provides minimal clinical benefit 14.

Sorafenib/NEXAVAR

Sorafenib, a multitargeted kinase inhibitor, is the only systemic agent shown to extend overall survival (OS) compared with placebo in patients with advanced HCC 15. However, the survival benefit with sorafenib is modest (a 2- to 3-month extension in median OS compared with placebo in two phase III trials) 16, 17

SIDE EFFECTS FROM SORAFENIB – Cardiac Ischemia and/or Infarction, Congestive Heart Failure,  Hemorrhage requiring medical intervention, gastrointestinal perforation, QT prolongation, (heart rhythm disorder that can cause fast, erratic heart beats),  Severe DILI – One of the leading causes of acute liver failure in the US. How ironic. Your liver drug will cause liver injury and possibly death while attempting to heal your liver. 

Grade 2: Painful erythema and swelling of the hands or feet and/or discomfort affecting the patient’s normal activities.

Moist desquamation, ulceration, blistering, or severe pain of the hands or feet, resulting in an inability to work or perform activities of daily living.

In the SHARP (HCC) study, the incidence of cardiac ischemia/infarction was 2.7% in NEXAVAR-treated patients. In multiple clinical trials, congestive heart failure has been reported in 1.9% of Nexavar-treated patients

Bleeding with a fatal outcome from any site was reported in 2.4% of NEXAVAR-treated patients.   In the TARGET
(RCC) study, bleeding regardless of causality was reported in 15.3% of patients. There was one fatal hemorrhage in each treatment group in the TARGET (RCC) study. In the DECISION (DTC) study, bleeding was reported in 17.4% of NEXAVAR-treated patients.

In the SHARP (HCC) study, hypertension was reported in 9.4% of NEXAVAR-treated patients. In the TARGET (RCC) study, hypertension was reported in 16.9% of NEXAVAR-treated patients. In the DECISION (DTC) study, hypertension was reported in 40.6% of NEXAVAR-treated patients. Ever wonder how the numbers can be so different? Pharma fraud usually has something to do with it.

There have been reports of severe dermatologic toxicities, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). These cases may be life-threatening. Gastrointestinal perforation is an uncommon adverse reaction and has been reported in less than 1% of patients.

Drug-Induced Liver Injury Sorafenib-induced hepatitis is characterized by a hepatocellular pattern of liver damage with significant increases
of transaminases which may result in hepatic failure and death.

THERE ARE SO MANY MORE TO LIST I will continue at the bottom of the page to get to the TACE info.

Conventional transcatheter arterial chemoembolization (c-TACE) is a widely used first-line palliative treatment for patients with unresectable hepatocellular carcinoma (HCC). Despite the effectiveness of c-TACE, to date, technique and procedure scheduling has not yet been standardized.

Serious complications currently occur in less than 5% of cases. Gallbladder inflammation, insignificant hair loss, and the formation of blood clots in the vessels are also possible. 

  • You may get a blood clot in your leg or arm. The clot may travel to your heart or brain and cause life-threatening problems, such as a heart attack or stroke. Medicine used during the procedure may cause shortness of breath or a lung infection. It may cause life-threatening harm to your stomach, liver, heart, or brain.
  • There is always a chance that embolization material can lodge in the wrong place and deprive normal tissue of its blood supply. However, mapping the pathway of the tumor and blood supply minimizes this risk.
  • There is a risk of infection after embolization, even if an antibiotic has been given.
  • Because angiography (which uses IV contrast)  is part of the procedure, there is a risk of an allergic reaction to the contrast material. The radiologic technologist will determine your allergies prior to the procedure.
  • Because angiography is part of the procedure, there is a risk of kidney damage in patients with diabetes or another pre-existing kidney disease.
  • Reactions to chemotherapy may include nausea, hair loss, a decrease in white blood cells,  platelets , and anemia. Because TACE traps most of the chemotherapy drugs in the liver, these reactions are usually mild.
  • Serious complications from TACE occur after about one in 20 procedures. Most major complications involve either infection in the liver or damage to the liver. Reporting indicates that approximately one in 100 procedures result in death, usually due to liver failure.

And the good news is it lasts a whole ten to fourteen months but you can go through this all over again and risk the complications about every year or so if the tumor starts to grow again. 

We’d like you to read our article on how chemotherapy can induce tumor metastasis. It’s a real eye-opener.

Post-embolization syndrome

Most patients experience a side effect called post-embolization syndrome; This includes pain, nausea, vomiting and fever.

In this study, we find data that says: In all, 70 patients (48.6%) had one or more complications within 30 days after the initial TACE procedure, and only 6 (4.2%) had severe complications (Dindo class ≥ 3), including one death. The most common complication was PES, occurring in a total of 52 patients (36.1%). Details of the specific complications are listed in Table – ​(Table11).

Yes, death, but your doctor will leave that out. We type this to bring this to your attention. The study also says: After adjusting for other important variables, PES was associated with an increased risk of death as compared with those without PES [HR 2.0 (95% CI 1.2–3.3); P = 0.011] Table ​(Table22).

Overall survival and post-embolization syndrome

Complications of gallbladder inflammation, insignificant hair loss, and the formation of blood clots in the vessels are also possible.  Serious complications currently occur in less than 5% of cases.

HERE IS THE MOST IMPORTANT PIECE OF INFO SO FAR:  Notwithstanding the improved survival observed with TACE, a number of prognostic factors such as vascular invasion and advanced liver disease have been found to carry a significantly worse prognosis, and TACE provides only a minimal survival benefit in these settings for which alternative and more effective therapies are evolving.

Predictors of Mortality in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

HIGHLIGHTS FROM THE ARTICLE:

Method: 109 patients underwent TACE. The primary outcome measured mortality. Kaplan–Meier analysis was used to determine the cumulative probability of death. Cox regression was used to assess the predictors of mortality.

 The American Association for the Study of Liver Diseases (AASLD) guideline recommends TACE for only intermediate-stage HCC (Barcelona stage B) [], it is not clear whether these guidelines are strictly adhered to in the community or whether other factors may be useful in determining outcomes after TACE.

The primary aim of this study was to determine the factors associated with mortality after TACE procedure among patients with HCC receiving TACE at a single center. The secondary aim was to determine the incidence of response and recurrence as well as factors associated with HCC response and recurrence after the TACE procedure.

CHART RESULTS FROM TACE PROCEDURE

Complete response 56 (51.4 %)
 Recurrence 27
 No recurrence 29
Incomplete response (> 30 % necrosis) 10 (9.2 %)
Partial response (< 30 % necrosis) 9 (8.3 %)

Progression (increase in size)

 23 (21 %)

Do you know if you have macroscopic vascular invasion (MVI)  Are you intermediate or advanced disease. I would think its the beginning stages right?

RESULTS FROM THIS STUDY:

Post-TACE complications

Any Complication70 (48.6%) 

Severe Complication (Dindo ≥3)a6 (4.2%)

See Below

GI bleeding4 (2.7%)

Severe hyperbilirubinemia (total bilirubin ≥7.0)2 (1.4%)

When extreme, hyperbilirubinemia may lead to the development of free bilirubin, that form of bilirubin which may cross the blood-brain barrier and enter and damage the basal nuclei of the brain. This rare, though devastating complication, may result in irreversible bilirubin induced brain damage termed kernicterus.

Respiratory failure1 (0.7%)  

Death (0.7%) 

Mild Complication64 (44.4%) 

PESb52 (36.1%)

Nausea/vomiting13 (9.0%)

Mild hyperbilirubinemia (total bilirubin <7.0)7 (4.9%) Ascites5 (3.5%) Ascites is the abnormal build-up of fluid in the abdomen. Technically, it is more than 25 ml of fluid in the peritoneal cavity, although volumes greater than one liter may ochttps://en.wikipedia.org/wiki/Abdomencur. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath. Complications can include spontaneous bacterial peritonitis.

Hepatic encephalopathy3 (2.1%)  – Loss of brain function 

Otherc17 (11.8%)

Severe complications classified as Dindo ≥ 3 includes patients who had one or more of the following that occurred within 30 days of the first TACE procedure: GI bleeding, severe hyperbilirubenemia (total bilirubin ≥7.0), and/or death.
bPost-embolization syndrome, defined as a fever with or without right upper quadrant abdominal pain within 14 days of the first TACE procedure.
cOther includes: acute kidney injury, urinary retention, hematoma, post-procedure anemia, pleural effusion, thrombocytopenia, and/or pneumonia.

AFP, alpha-fetoprotein; BCLC, Barcelona Clinic Liver Cancer; DEB-TACE, beads; BMI, body mass index; GI, gastrointestinal; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; PES, post-embolization syndrome; TACE, transarterial chemoembolization.

TACE Lessens Survival Rate

A number of studies have shown an association between inflammatory markers after TACE and worse survival. –

Inflammatory markers are associated with outcome in patients with unresectable hepatocellular carcinoma undergoing transarterial chemoembolization – link

Conclusions: Our study demonstrates that periprocedural trends of serum NLR –  neutrophil-lymphocyte ratio are associated with outcomes in unresectable HCC undergoing TACE. Serum NLR is easy to calculate from a routine complete blood count with differential. Along with liver function, serum NLR may be helpful to clinicians in providing prognostic information and monitoring response to therapy.

Normal NRL values between 0.78 and 3.53 

Predictors of Mortality in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization – Link

Transarterial chemoembolization (TACE) is the recommended treatment for patients with Barcelona stage B hepatocellular carcinoma; however, community practice varies from these American Association for the Study of Liver Diseases guidelines.

CalliSpheres drug-eluting beads versus lipiodol transarterial chemoembolization in the treatment of hepatocellular carcinoma: short-term efficacy and safety study

A total of 54 patients with HCC treated by TACE from June 2016 to February 2017 were retrospectively analyzed. These included 24 cases in the DEB-TACE group and 30 cases in the cTACE group.

DEB-TACE – drug-eluting beads transarterial chemoembolization  – using Doxorubicin

(cTACE) Conventional TACE

Drug-eluting beads (DEBs) have been imposed as novel drug-delivering agents for TACE, which allows for higher concentrations of drugs within the target tumor and lower systemic concentrations compared with cTACE. Despite the theoretical advantages of DEB-TACE, it is still controversial in clinical practice as to whether DEB-TACE is superior to cTACE in regard to overall survival and treatment response.

Table 5 Comparison of complications induced by TACE therapy between DEB-TACE and cTACE

From: CalliSpheres drug-eluting beads versus lipiodol transarterial chemoembolization in the treatment of hepatocellular carcinoma: a short-term efficacy and safety study

Complications DEB-TACE cTACE χ2 value p value
Post-embolization syndrome 15 (62.5%) 26 (81.3%) 4.260 0.039
Transient liver injury 11 (46%) 20 (67%) 2.367 0.124
Liver abscess 1 (4.1%) 0 1.274 0.259
Ascites 3 (13%) 8 (27%) 1.650 0.199
Myelosuppression 1 (4.1%) 9 (30%) 5.897 0.015
Granulocyte reduction 2 (8.3%) 13 (43%) 8.142 0.004

Myelosuppression

Myelosuppression, also known as bone marrow suppression, is a decrease in bone marrow activity that results in reduced production of blood cells. Some blood cell disorders include:

  • fewer red blood cells (anemia)
  • fewer white blood cells (neutropenia)
  • fewer platelets (thrombocytopenia)

a number of side effects that result from low blood cell counts can have significant effects on an individual’s health. While the majority of side effects are not life threatening, they can dramatically affect the patient’s short-term quality of life.

Symptoms associated with myelosuppression vary depending on the specific type. The most common side effects of anemia include fatigue, dizziness and shortness of breath. Depending on the severity, anemic patients may also exhibit pale skin, especially at the lips and nail beds. Increased heart rate is another common symptom of anemia.

Neutropenia results in a reduction in the body’s ability to fight off disease. As a result, fever and chills are the most common side effect of reduced white blood cells. Signs of infection may also be present, including swelling, redness or an area that is warm to the touch. Other common neutropenia side effects include diarrhea and rash.

Thrombocytopenia is most commonly characterized by easy bruising and bleeding from the nose, gums or mouth. Blood may also show up in urine or bowel movements. Small red spots on the skin, called petechiae, may also manifest.

Other signs of external bleeding include:

  • Prolonged bleeding, even from minor cuts
  • Bleeding or oozing from the mouth or nose, especially nosebleeds or bleeding from brushing your teeth
  • Abnormal vaginal bleeding (especially heavy menstrual flow)

A lot of bleeding after surgery or dental work also might suggest a bleeding problem.

Heavy bleeding into the intestines or the brain (internal bleeding) is serious and can be fatal. Signs and symptoms include:

  • Blood in the urine or stool or bleeding from the rectum. Blood in the stool can appear as red blood or as a dark, tarry color. (Taking iron supplements also can cause dark, tarry stools.)
  • Headaches and other neurological symptoms. These problems are very rare, but you should discuss them with your doctor.

HOLY CRAP I PUT A LOT OF INFO IN HERE. MAKE SURE YOU CLICK ALL OF THE LINKS TO THE MEDICAL PAPERS AND SOURCES.

ADDITIONAL INFO FOR ME TO PUT IN ABOVE

Serum enzyme activities do not measure liver functions; BILI and INR do

Hyperbilirubinemia in HCC with BDTT is considered a relative contraindication for TACE due to the high risk of post-procedural liver failure. Besides, high serum total bilirubin level has always been used as a representative of bad hepatic functional reserve.

Specifically, a complication of BDTT caused by TACE should be highlighted. When necrotic debris of tumor thrombus is separated from the main BDTT and floats into the common bile duct following TACE, clinical symptoms of obstructive jaundice will appear, which should be distinguished from jaundice caused by temporary liver insufficiency after TACE. This complication can be relieved by endoscopy-assisted thrombectomy or stent implantation.

 When selecting patients for TACE therapy, guidelines only consider tumor characteristics, performance status and liver function. Other factors such as histological features of the tumor, etiology of HCC or other comorbidities are not considered.

Following a number of previous clinical trials demonstrating discordant results, two clinical trials, one performed in a European patient population [] and the other in an Asian patient population [], showed an improvement in overall survival in patients with unresectable HCC when treated with TACE, compared with symptomatic treatment. However, the benefit demonstrated in these patients was likely due to very strict selection criteria, in which only ∼12–20% of trial entrants passed the exclusion criteria. In Asian countries, the use of adjuvant TACE following surgical resection remains the first-line palliative treatment for HCC, despite mixed success in randomized control trials, with some trials demonstrating a benefit and others demonstrating no effect or even a harmful effect [].

Effect of sustained virological response on long-term clinical outcome in 113 patients with compensated hepatitis C-related cirrhosis treated by interferon alpha and ribavirin

2003 – Were the journals less corrupt back then?? Or was it because these are HIGHLY TOXIC DRUGS.

Wu et al[] have studied the effect of pre-operative TACE (preTACE) on resetability and curability in management of huge resectable HCC. Although preTACE induced tumor shrinkage as expected, the shrinkage of tumor didn’t result in an easy operation, on the contrary, the preTACE group had a longer operative time, more blood loss, more extra-hepatic metastasis, higher possibility of invading adjacent organs by tumors and removal of adjacent organs; furthermore, the disease-free survival (DFS) in preTACE group was not statistically different with that in the control group, the overall survival (OS) was even worse than that in control group. The author suggested that preTACE delayed the resection, which may leave tumor more time to develop intra-hepatic or distant metastasis; in addition, preTACE can’t eliminate tumor cells completely, therefore, preTACE for resectable huge HCC was not recommended.

A number of clinical trials have evaluated the use of TACE in combination with other targeted antiangiogenic agents, but most have been met with negative outcomes. For example, Phase III trials evaluating brivanib, a dual inhibitor of VEGFR and FGFR [], and orantinib, an inhibitor of VEGFR and PDGFR [], both failed to demonstrate improved overall survival with combination therapy. Two Phase II trials evaluated bevacizumab, an anti-VEGF monoclonal antibody, in combination with TACE, which demonstrated the use of bevacizumab to exhibit antitumor activity, thus warranting further studies [,], although no Phase III trials are currently underway.

This website is for information purposes only; we are not diagnosing, treating, curing, mitigating, or preventing any disease or medical condition by providing the information contained herein. Before beginning any natural, integrative or conventional treatment regimen, it is advisable to seek the advice of a licensed healthcare professional.