Safety of Drug-Eluting-Beads Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma in Patients with Transjugular Intrahepatic Portosystemic Shunt

Abstract

Abstract Purpose To assess the safety of drug-eluting beads transarterial chemoembolization (DEB-TACE) for unresectable hepatocellular carcinoma (HCC) in patients with transjugular intrahepatic portosystemic shunt (TIPS). Materials and Methods Records of patients with a patent TIPS who underwent DEB-TACE for inoperable HCC from 2005 to 2014 at two institutions were reviewed. Patient demographics, number of procedures, extent of embolization (lobar vs. segmental), 30-day mortality, and postprocedure adverse events classified based on Common Terminology Criteria for Adverse Events (CTCAE V4.03) were recorded. Results From the total of 10 patients included (6 male, average age: 59), 3 were classified as Child A and 7 as B. Tumor Barcelona clinic liver cancer (BCLC) stage was A in three patients, B in six, and C in one. Patients underwent doxorubicin DEB-TACE with a median dose of 100 mg (range: 50–100). Number of TACE procedures per patient ranged from 1 to 4 (median: 1). Three (30%) patients experienced toxicity grade 2 or higher immediately following the procedure. One patient had grade 3 toxicity of aspartate transaminase (AST), alanine transaminase (ALT), and bilirubin. Three patients had extended hospital stays beyond 48 hours due to adverse events, including edema, acute pancreatitis, and a hepatic abscess discovered a week after the procedure. All 10 patients were alive and discharged from the hospital at 30 days after the procedure. Conclusion DEB-TACE can be well tolerated by patients with a patent TIPS, given adequate liver function. Lobar DEB-TACE is associated with higher risk of complications.