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

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).

Severe Manifestations and Grave Prognosis in Young Patients with Gastric Cancer in Thailand.

BACKGROUND: Gastric cancer is the second leading cause of cancer death worldwide and occurs most frequently in the age group of 5070 years. Rarely reports have appeared regarding younger age groups. The purpose of this study was to compare clinical characteristics and outcome of treatment between young and elderly patients with gastric cancer in Thailand. MATERIALS AND METHODS: Clinical information, histological features, endoscopic findings and treatment outcome were reviewed and collected from Thammasat University Hospital, Pathumthani and Bangkok Medical Center, Bangkok, Thailand between September 2011March 2015. RESULTS: A total of 154 gastric tumor patients including 101 with benign tumors (22 males and 79 females, mean age= 62.6 years) and 53 with gastric cancers (27 males and 26 females, mean age= 60.6 years) were enrolled in this study. Gastric cancer patients presented with alarm symptoms such as anemia, anorexia and weight loss significantly more frequently than benign gastric tumor patients. In gastric cancer patients, mean duration of symptoms prior to diagnosis was shorter in younger (<40 years) than older patients (age ≥40 years) (73.3 days vs 84.8 days). Family history of GI malignancy and diffuse type of gastric cancer were significant greater in younger than older patients (36% vs 5% P=0.01; OR= 11.4, 95%CI = 1.874.7 and 73% vs 14%, P<0.01; OR= 16, 95%CI = 3.378, respectively) and 5year survival rates were 9% in younger age patients and 19% in older age group. CONCLUSIONS: Most young patients with gastric cancer in Thailand feature aggressive manifestations with poorer prognosis than elderly patients. Early detection of gastric cancer in high risk young patients might be important key to improve survival rate and treatment outcome in this particular group.