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N-Acetylcysteine Prevents Post-embolization Syndrome in Patients with Hepatocellular Carcinoma Following Transarterial Chemoembolization

  • Sith SiramolpiwatEmail author
  • Thanachai Punjachaipornpon
  • Bubpha Pornthisarn
  • Ratha-korn Vilaichone
  • Soonthorn Chonprasertsuk
  • Anupong Tangaroonsanti
  • Patommatat Bhanthumkomol
  • Achara Phumyen
  • Atipat Yasiri
  • Mayurachat Kaewmanee
Original Article
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Abstract

Background

Post-embolization syndrome is a common complication after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). N-acetylcysteine (NAC) is known to ameliorate liver damage from several causes.

Aim

To determine the efficacy of intravenous NAC in the prevention of post-embolization syndrome in HCC patients following TACE.

Methods

In this study, patients with HCC admitted for TACE were prospectively enrolled. All patients were randomized stratified by Child A or B to receive NAC or placebo. The NAC group received intravenous NAC 24 h prior to TACE (150 mg/kg/h for 1 h followed by 12.5 mg/kg/h for 4 h, then continuous infusion 6.25 mg/h for 48 h after the procedure). The placebo group received an infusion of 5% glucose solution until 48 h after procedure. The post-embolization syndrome was defined as: T ≥ 38.5 c and serum ALT > 3 times of pretreatment value.

Results

In total, 111 HCC patients were enrolled; 57 were randomly assigned to NAC group and 54 to placebo group. The incidence of post-embolization syndrome was lower in NAC group (24.6%) compared to placebo group (48.2%); P = 0.01. On multivariate analysis, receiving IV NAC (P = 0.03) and HCC diameter (P < 0.01) were associated with developing post-embolization syndrome. Post-TACE liver decompensation was documented in 26/111 (23.4%) patients. There was no difference in the incidence of post-TACE liver decompensation between NAC and placebo group.

Conclusions

In this study, intravenous NAC administration reduces the incidence of post-embolization syndrome after TACE in patients with HCC. However, it does not prevent post-TACE liver decompensation.

Trial Registration Number

This study was registered with Thai Clinical Trial Registry (TCTR20150313002).

Keywords

Hepatocellular carcinoma N-acetylcysteine Post-embolization syndrome Liver cancer 

Abbreviations

TACE

Transarterial chemoembolization

HCC

Hepatocellular carcinoma

NAC

N-acetylcysteine

BCLC

Barcelona clinic liver center

HBV

Hepatitis B virus

HCV

Hepatitis C virus

MELD

Model for end-stage liver disease

PV

Portal vein

AST

Aspatate aminotransferase

ALT

Alanine aminotransferase

5-FU

5-Fluorouracil

WBC

White blood cell

Notes

Acknowledgments

This work was funded by Faculty of Medicine and Chulabhorn International College of Medicine, Thammasat University, Thailand, and Gastrointestinal Association of Thailand.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sith Siramolpiwat
    • 1
    • 2
    Email author
  • Thanachai Punjachaipornpon
    • 1
  • Bubpha Pornthisarn
    • 1
  • Ratha-korn Vilaichone
    • 1
    • 2
  • Soonthorn Chonprasertsuk
    • 1
  • Anupong Tangaroonsanti
    • 1
  • Patommatat Bhanthumkomol
    • 1
  • Achara Phumyen
    • 2
  • Atipat Yasiri
    • 2
  • Mayurachat Kaewmanee
    • 2
  1. 1.Division of Gastroenterology, Department of Internal Medicine, Faculty of MedicineThammasat UniversityPathum ThaniThailand
  2. 2.Chulabhorn International College of MedicineThammasat UniversityPathum ThaniThailand

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