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Predisposing Factors of Liver Necrosis after Transcatheter Arterial Chemoembolization in Liver Metastases from Neuroendocrine Tumor

Julien Joskin 1 Thierry de Baere 1 Anne Aupérin 2 Lambros Tselikas 1 Boris Guiu 1, 3, 4 Geoffroy Farouil 1 Valérie Boige 5 David Malka 5 Sophie Leboulleux 6 Michel Ducreux 5 Eric Baudin 6 Frédéric Deschamps 1
1 Imagerie thérapeutique (radiologie interventionnelle)
Département d'imagerie médicale [Gustave Roussy]
2 SBE - Service de biostatistique et d'épidémiologie
3 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
4 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier
5 Oncologie digestive
Département de médecine oncologique [Gustave Roussy]
6 Médecine nucléaire
Département d'imagerie médicale [Gustave Roussy]
Abstract : PURPOSE: To investigate predictive factors for liver necrosis after transcatheter arterial chemoembolization (TACE) of neuroendocrine liver metastases. METHODS: A total of 164 patients receiving 374 TACE were reviewed retrospectively to analyze predictive factors of liver necrosis. We analyzed patient age and sex; metastasis number and location; percentage of liver involvement; baseline liver function test; and pretreatment imaging abnormalities such as bile duct dilatation (BDD), portal vein narrowing (PVN), and portal vein thrombosis (PVT). We analyzed TACE technique such as Lipiodol or drug-eluting beads (DEB) as the drug's vector; dose of chemotherapy; diameter of DEB; and number, frequency, and selectivity of TACE. RESULTS: Liver necrosis developed after 23 (6.1 %) of 374 TACE. In multivariate analysis, DEB > 300 μm in size induced more liver necrosis compared to Lipiodol (odds ratio [OR] 35.20; p < 0.0001) or with DEB < 300 μm in size (OR 19.95; p < 0.010). Pretreatment BDD (OR 119.64; p < 0.0001) and PVT (OR 9.83; p = 0.030) were predictive of liver necrosis. BDD or PVT responsible for liver necrosis were present before TACE in 59 % (13 of 22) and were induced by a previous TACE in 41 % (9 of 22) of cases. CONCLUSION: DEB > 300 μm in size, BDD, and PVT are responsible for increased rate of liver necrosis after TACE. Careful analysis of BDD or PVT on pretreatment images as well as images taken between two courses can help avoid TACE complications.
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https://hal.umontpellier.fr/hal-02279565
Contributeur : Anthony Herrada <>
Soumis le : jeudi 5 septembre 2019 - 13:35:41
Dernière modification le : jeudi 19 septembre 2019 - 11:08:05

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UNIV-MONTPELLIER | VALDAURELLE | FNCLCC | BS | IRCM | UNIV-PARIS-SACLAY | IGR

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Julien Joskin, Thierry de Baere, Anne Aupérin, Lambros Tselikas, Boris Guiu, et al.. Predisposing Factors of Liver Necrosis after Transcatheter Arterial Chemoembolization in Liver Metastases from Neuroendocrine Tumor. CardioVascular and Interventional Radiology, Springer Verlag, 2015, 38 (2), pp.372-380. ⟨10.1007/s00270-014-0914-1⟩. ⟨hal-02279565⟩

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