Low-Dose and Short-Course Dexamethasone Treatment as a New Therapy against the Post-Embolization Syndrome after Transcatheter Arterial Chemoembolization in Primary Liver Cancer: A Retrospective Case-Control Study

Research Article

Austin J Med Oncol. 2022; 9(1): 1072.

Low-Dose and Short-Course Dexamethasone Treatment as a New Therapy against the Post-Embolization Syndrome after Transcatheter Arterial Chemoembolization in Primary Liver Cancer: A Retrospective Case-Control Study

Meng YB1#, Cheng SM2#, Yao M1#, Xu XW1, Chen L3, Zhu XJ3 and Du J2*

¹Department of Oncology Traditional Chinese Medicine, Changhai Hospital, Navy Military Medical University, China

²School of Traditional Chinese Medicine, Navy Military Medical University, China

³Department of Pharmacy, Changhai Hospital, Navy Military Medical University, China

#These authors have contributed equally to this article.

*Corresponding author: Juan Du Department of Traditional Chinese Medicine, Navy Military Medical University, Shanghai 200433, China

Received: November 07, 2022; Accepted: December 16, 2022; Published: December 22, 2022

Abstract

Objective: Dexamethasone (DEX) is considered an effective treatment for Post-Embolization Syndrome (PES). However, the current commonly used DEX treatment course is long and involves a large amount of DEX and thus causes substantial side effects. This study aimed to evaluate the efficacy and safety of low-dose shortcourse DEX treatment in the prevention of PES to establish a new treatment course.

Methods: A retrospective cohort study was conducted to observe the efficacy of DEX in treating PES on patients with primary liver cancer who underwent Transcatheter Arterial Chemoembolization (TACE). DEX was selected according to the wishes of the patients, who were subsequently divided into two groups. In the experimental group, 52 patients daily received an intravenous injection of 5 mg DEX and 5 mg tropisetron, starting on the day of TACE. The remaining 52 patients (control group) were treated with only 5 mg tropisetron daily. Incidence and degree of vomiting, abdominal pain, and fever were recorded. Routine blood tests and the C-Reactive Protein (CRP) test were performed, liver and kidney functions were evaluated, and the coagulation index and Eastern Cooperative Oncology Group (ECOG) performance status were assessed before and after TACE.

Results: Severity scores of adverse reactions, such as vomiting, fever, and abdominal pain; incidence of grade 2 and 3 adverse reactions; and CRP and ECOG scores were significantly lower in the experimental group than in the control group (P< 0.05). There was no significant difference in routine blood parameters, liver and kidney functions, or coagulation between the two groups before or after TACE (P> 0.05).

Conclusion: Low-dose and short-course DEX treatment after TACE can effectively reduce the severity of PES without side effects.

Keywords: Post-embolization syndrome; TACE; Dexamethasone; Liver cancer

Introduction

Liver cancer is the second leading cause of cancer-related deaths in China and worldwide [1]. Hepatocellular Carcinoma (HCC) accounts for 85–90% of patients with liver cancer. By the time of definitive diagnosis, most patients are already advanced and have lost the opportunity for surgical resection [2]. In addition to surgical resection, liver transplantation, Transcatheter Arterial Chemoembolization (TACE), and ablation are also strategies used for the treatment of liver cancer. TACE is the most commonly used treatment for most patients with multinodular HCC [3]. However, the side effects after TACE are substantial and include persistent high fever, vomiting, and severe abdominal pain, collectively referred to as Post-Embolization Syndrome (PES) [4]. PES lowers the life quality of patients, reduces treatment tolerance, and delays post-operative recovery. Studies have shown that the occurrence of PES is closely related to embolic ischemia and embolic inflammatory response [5]. Dexamethasone (DEX) has been shown to be effective in preventing PES [6-8]. However, long-term and high-dose use of glucocorticoids causes other side effects [9]. Effective suppression of the embolic reaction after interventional surgery and minimization of the side effects caused by glucocorticoids are essential for the earliest post-operative recovery with the maximum curative effect and minimum impact on the life quality of patients. This retrospective cohort study was conducted to assess for the therapeutic effect of daily low-dose DEX administration on the PES after TACE in 104 patients with liver cancer in Shanghai Changhai Hospital, so as to provide a reference for future clinical studies.

Methods

This retrospective cohort study was conducted in Shanghai Changhai Hospital between October 2019 and October 2020. Primary liver cancer was diagnosed via histological or imaging evaluation according to the guidelines of the Chinese Society of Clinical Oncology [10]. The enrolled patients met the requirements for TACE indications and did not use glucocorticoids for the 3 months preceding TACE.

Patients who had any of the following were excluded [11]: (1) an organ disease, such as one involving the heart, brain, kidney, or lung; (2) portal vein tumor thrombosis, cholangiocarcinoma thrombosis, or collateral vessel formation; (3) severe esophageal varices in the fundus of the stomach, severe portal hypertension, or a risk of rupture and bleeding; (4) systemic infection with sepsis or liver abscess; (5) Child-Pugh C liver function; (6) severe liver cirrhosis; (7) tumors accounting for = 70% of the whole liver; and (8) allergic constitution or allergic to the study drugs.

The study was approved by the Institutional Review Board of Changhai Hospital (CHEC2010112) and adhered to the tenets of the Declaration of Helsinki.

Results

Patient Characteristics

This clinical study included 104 patients with primary liver cancer who received liver TACE treatment in the Traditional Chinese Medicine (TCM) oncology department of Changhai Hospital between October 2019 and October 2020. These patients were divided into the following two groups based on their willingness to be treated with DEX: the experimental group consisted of 52 patients daily intravenously injected with both 5 mg DEX and 5 mg tropisetron after TACE, and the remaining 52 patients (control group) were injected only with 5 mg tropisetron. At the baseline, there was no significant difference in gender, age, liver function grade, or tumor stage between the two groups (Table 1), P> 0.05.