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Abstract
Background Transarterial chemoembolization (TACE) is the treatment for patients with unresectable hepatocellular carcinoma (HCC) where there is no vascular invasion or extrahepatic spread. TACE causes significant death to tumor cells, leading to inflammation. This may cause post-embolization syndrome (PES), which manifests as fever, nausea, or vomiting. Although self-limiting, PES causes increased hospitalization time and decreases the overall quality of life of the patient. Hence, reducing its side effects, or better - preventing it - will greatly benefit its recipients. The aim of this study is to evaluate the efficacy of dexamethasone in reducing the incidence of PES after TACE in patients with HCC.
Methods Randomized controlled trials were included in this meta-analysis. Only published studies on patients aged >18 years diagnosed with HCC Child-Pugh class A or B without microvascular invasion and extrahepatic metastases undergoing TACE were included. Patients with HCC Child-Pugh C were excluded. Patients with concurrent serious medical conditions, such as underlying cardiac or renal disease, other concurrent primary malignancy, or the use of other chemotherapy, such as hepatic arterial infusion, chemotherapy, or systemic chemotherapy, were excluded from the study. Studies that measured the incidence of fever, nausea, and vomiting post-TACE after prophylactic administration with dexamethasone were included, while those that used other agents in combination with dexamethasone for prophylaxis (e.g., ginsenosides, N-acetylcysteine) were excluded.
Results The pooled studies showed that dexamethasone significantly reduced the incidence of fever after TACE (P <0.00001), (IDDF2024-ABS-0022- Figure 1. Incidence of fever post-TACE between dexamethasone and control groups). The overall risk ratio for developing fever was 0.49 (95% CI: 0.37-0.66). Nausea was also significantly reduced with dexamethasone administration (P 0.0004), the overall risk ratio being 0.67 (95% CI: 0.54-0.83), (IDDF2024-ABS-0022- Figure 2. Incidence of nausea post-TACE between dexamethasone and control groups). Reduction in the incidence of vomiting with dexamethasone administration is inconclusive (P 0.53), (IDDF2024-ABS-0022- Figure 3. Incidence of vomiting post-TACE between dexamethasone and control group).
Incidence of fever post-TACE between dexamethasone and control groups
Incidence of nausea post-TACE between dexamethasone and control groups
Incidence of vomiting post-TACE between dexamethasone and control group
Conclusions Among patients with HCC who underwent TACE, dexamethasone prophylaxis was found to be effective in reducing the incidence of post-embolization syndrome, specifically fever and nausea. Its effect on vomiting is inconclusive. This supports the use of dexamethasone prophylaxis, which can significantly shorten the length of hospitalization and ultimately improve the quality of life of patients with HCC undergoing TACE.