Clinical Trials Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
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, Wasu Tanasoontrarat, Torpong Claimon, Supatsri Sethasine
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 by the 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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
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
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.