RESUMO
PURPOSE: To evaluate the predictors of toxicity of drug-eluting beads loaded with irinotecan (DEBIRI) in the treatment of hepatic malignancies. MATERIALS AND METHODS: A total of 330 patients were enrolled in a prospective, open-label, multicenter, multinational, single-arm study administering two types of drug-eluting beads (DEBIRI and drug-eluting beads loaded with doxorubicin). Complications were graded by Cancer Therapy Evaluation Program's Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. All events requiring additional physician treatment or requiring extended hospital stay or readmission within 30 days were included. RESULTS: A total of 109 patients received 187 DEBIRI treatments (range 1 to 5 per patient). The most common histology was metastatic colorectal cancer in 76% of patients, cholangiocarcinoma in 7% of patients, and other metastatic disease in 17% of patients. There were 35 patients (19%) with irinotecan treatments who sustained 158 treatment-related adverse events, with the median CTCAE event grade being CTCAE grade 2 (range 1 to 5). The most common adverse events were postembolic symptoms (42%). Multivariate analysis identified pretreatment and treatment-related risk factors as follows: lack of pretreatment with hepatic arterial lidocaine (p = 0.005), > or = 3 treatments (p = 0.05), achievement of complete stasis (p = 0.04), treatment with >100 mg DEBIRI in 1 treatment (p = 0.03), and bilirubin >2.0 microg/dl with >50% liver involvement (p = 0.05). These factors were predictive of adverse events and significantly greater hospital length of stay. CONCLUSIONS: DEBIRI is safe when appropriate technique and treatment are used. Adverse events can be predicted based on pretreatment- and treatment-related factors, and their occurrence can become part of the informed consent process. Continued standardization of this treatment will lead to fewer adverse events and improved patient quality of life.
Assuntos
Camptotecina/análogos & derivados , Quimioembolização Terapêutica/efeitos adversos , Colangiocarcinoma/secundário , Neoplasias Colorretais/secundário , Doxorrubicina/administração & dosagem , Portadores de Fármacos/efeitos adversos , Neoplasias Hepáticas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Camptotecina/administração & dosagem , Camptotecina/efeitos adversos , Quimioembolização Terapêutica/métodos , Intervalos de Confiança , Doenças do Sistema Digestório/etiologia , Relação Dose-Resposta a Droga , Doxorrubicina/efeitos adversos , Feminino , Seguimentos , Doenças Hematológicas/etiologia , Humanos , Hipertensão/etiologia , Irinotecano , Tempo de Internação , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Resultado do TratamentoRESUMO
An asymptomatic young woman was found to have a continuous machinery murmur over the second right interspace near the sternum. Investigations showed an arteriovenous fistula involving the right internal thoracic artery and accompanying vein. Selective transcatheter embolization was successfully performed.
