Simasingha N, Tanasoontrarat W, Claimon T, Sethasine S. Efficacy of dexamethasone and N-acetylcysteine combination in preventing post-embolization syndrome after transarterial chemoembolization in hepatocellular carcinoma. World J Gastroenterol 2023; 29(5): 890-903 [PMID: 36816622 DOI: 10.3748/wjg.v29.i5.890]
Corresponding Author of This Article
Supatsri Sethasine, MD, Associate Professor, Chief Doctor, Department of Internal Medicine, Navamindradhiraj University, Vajira Hospital Dusit Thailand, Bangkok 10300, Thailand. supatsri@nmu.ac.th
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Clinical Trials Study
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Simasingha N, Tanasoontrarat W, Claimon T, Sethasine S. Efficacy of dexamethasone and N-acetylcysteine combination in preventing post-embolization syndrome after transarterial chemoembolization in hepatocellular carcinoma. World J Gastroenterol 2023; 29(5): 890-903 [PMID: 36816622 DOI: 10.3748/wjg.v29.i5.890]
World J Gastroenterol. Feb 7, 2023; 29(5): 890-903 Published online Feb 7, 2023. doi: 10.3748/wjg.v29.i5.890
Efficacy of dexamethasone and N-acetylcysteine combination in preventing post-embolization syndrome after transarterial chemoembolization in hepatocellular carcinoma
Nitipon Simasingha, Supatsri Sethasine, Department of Internal Medicine, Navamindradhiraj University, Bangkok 10300, Thailand
Wasu Tanasoontrarat, Torpong Claimon, Department of Radiology, Navamindradhiraj University, Bangkok 10300, Thailand
Author contributions: Simasingha N and Sethasine S contributed to the conception and design of the study, data collection, and statistical analysis, and data interpretation; Tanasoontrarat W and Claimon T conducted TACE; Sethasine S contributed to drafting of the article and critical revision of the manuscript; and all authors read and approved the final manuscript.
Supported bythe Navamindradhiraj University Research Fund and the Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 93/2564.
Institutional review board statement: The study was approved by the Institutional Review Board of the Faculty of Medicine, Vajira Hospital (COA 051/2564).
Clinical trial registration statement: The trial was registered at Thai Clinical Trial Registry, registration number TCTR20220412008.
Informed consent statement: All participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data used in the current study are available from the corresponding author upon reasonable request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared according to the CONSORT 2010 statement.
Corresponding author: Supatsri Sethasine, MD, Associate Professor, Chief Doctor, Department of Internal Medicine, Navamindradhiraj University, Vajira Hospital Dusit Thailand, Bangkok 10300, Thailand. supatsri@nmu.ac.th
Received: October 24, 2022 Peer-review started: October 24, 2022 First decision: December 12, 2022 Revised: December 17, 2022 Accepted: January 16, 2023 Article in press: January 16, 2023 Published online: February 7, 2023 Processing time: 105 Days and 5.4 Hours
ARTICLE HIGHLIGHTS
Research background
Transarterial chemoembolization (TACE) is the current standard treatment for intermediate-stage hepatocellular carcinoma (HCC). Post-embolization syndrome (PES) is a complex clinical syndrome which may occur after conventional TACE (cTACE). Either N-acetylcysteine (NAC) or dexamethasone (DEXA) is used to prevent PES.
Research motivation
The synergistic effect of the combined therapy for preventing PES and liver decompensation has not been determined.
Research objectives
The aim of this study was to evaluate the efficacy of NAC and DEXA combination in preventing PES and liver decompensation after cTACE.
Research methods
A single-center randomized controlled clinical trial.
Research results
Our study provides clinical evidence that intravenous NAC plus DEXA administration ameliorates the occurrence of post-TACE PES in patients with intermediate-stage HCC. Interestingly, we found that a dynamic change in Albumin-Bilirubin (ALBI) score was a risk factor for post-TACE liver decompensation.
Research conclusions
A combination of NAC and DEXA ameliorated the occurrence of PES after cTACE in patients with intermediate-stage HCC.
Research perspectives
The application of dynamic increase in ALBI score for a prediction of early post-TACE liver decompensation requires further research.
