RESUMO
We conducted a retrospective analysis to evaluate the risk factors associated with the occurrence of acute hepatic failure following transcatheter arterial embolization (TAE) for hepatocellular carcinoma. From 1984 to 1993 we performed a total of 623 embolization procedures in 369 patients with both hepatocellular carcinoma and chronic liver disease. Within 2 weeks after TAE, 13 patients (2.1%) experienced hepatic failure as characterized by a rapid increase in serum bilirubin levels and the development of hepatic encephalopathy of grade 2 or higher. These results indicated that the following are risk factors for acute hepatic failure after TAE: poor hepatic functional reserve; high-dose infusion of chemotherapeutic agents, and a history of multiple embolization procedures.
Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/efeitos adversos , Falência Hepática Aguda/complicações , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Bilirrubina/sangue , Bilirrubina/metabolismo , Doxorrubicina/administração & dosagem , Estudos de Avaliação como Assunto , Feminino , Humanos , Falência Hepática Aguda/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Tempo de Protrombina , Embolia Pulmonar/etiologia , Embolia Pulmonar/mortalidade , Fatores de Risco , Albumina Sérica/metabolismoRESUMO
METHODS: Thirty-two tumors in 30 patients with hepatocellular carcinoma (HCC) were studied preoperatively using PET with 18F-labeled 2-fluoro-2-deoxy-D-glucose (FDG) to evaluate the metabolic activity of the lesions after interventional therapy. All patients had received transcatheter arterial chemoembolization therapy using iodized oil (Lipiodol, Laboratoire Guerbet, Alnaysous-Bois, France) before the PET study. The tumors were 2 to 18 cm in diameter. FDG uptake at 48 to 60 min after tracer injection was used to determine the standardized uptake value (SUV). The SUVs of the tumor and nontumor regions of the liver were calculated to obtain the tumor-to-nontumor ratio (SUV ratio). The PET results were compared with the findings of CT and histologic examination. RESULTS: The tumors were divided into three types, consisting of those with increased FDG uptake (SUV ratio of 1.07-2.66, Type A, n = 19), similar FDG uptake to the surrounding nontumor region (SUV ratio of 0.77-1.04, Type B, n = 7) and decreased or absent FDG uptake (SUV ratio of 0.13-0.58, Type C, n = 6). In histologic examination, viable HCC tissue remained in all Type A and B tumors, whereas more than 90% necrosis was found in the Type C tumors, indicating that interventional therapy had been effective. These PET findings reflected tumor viability more accurately than the extent of intratumor Lipiodol retention on CT images. CONCLUSION: FDG-PET appears to be a valuable method for the assessment of tumor viability after interventional therapy for HCC.