Cardiopulmonary assessment of patients with unresectable hepatocellular carcinoma treated by transarterial chemoembolization

Abstract

ObjectivesTo assess the effect of transarterial chemoembolization (TACE) on cardiopulmonary functions in patients with unresectable hepatocellular carcinoma (HCC). MethodsThis prospective cohort study included 300 patients with unresectable HCC candidate for treatment by TACE. Pulmonary function tests (PFT) and echocardiography were evaluated one day before and one month after TACE. Assessment of response to TACE was according to modified Response Evaluation Criteria in Solid Tumor (mRECIST) evaluated by triphasic computed tomography (CT) or dynamic magnetic resonance image (MRI) one month after TACE. ResultsTACE produced significant increase in lung restriction in patients achieved partial response (PR) (P = 0.002) and patients with stable disease (SD) (P = 0.014) but no significant changes occurred in patients achieved complete response (CR). Left ventricular strain was observed in patients achieved CR as a decrease in left ventricular ejection fraction (LVEF) (P = 0.01) and global longitudinal scale (GLS) (P = 0.001), PR as a decrease in LVEF (P = 0.003) and GLS (P < 0.0001), and those with SD as a decrease in LVEF (P < 0.0001). ConclusionTACE has some deleterious cardiopulmonary effects that can be assessed by echocardiography and PFT. Patients with PR and SD could be evaluated for FVC and LVEF before a second TACE session.