Can Prophylactic Dexamethasone Alleviate Postembolization Syndrome?

Prophylactic administration of dexamethasone prior to chemoembolization can effectively alleviate postembolization syndrome (PES), according to a study published in JVIR.

Researchers conducted a prospective, randomized, double-blind, placebo-controlled trial from August 2015 to June 2016. The trial, which took place in a single center, included 44 patients with intermediate-stage hepatocellular carcinoma (HCC) who were randomized to receive dexamethasone and 44 patients who were randomized to the control group. Patients in the treatment group received 12 mg of intravenous dexamethasone before undergoing chemoembolization.

PES was defined as having either nausea, vomiting, fever, pain, and/or increased alanine aminotransferase (ALT) level. “To overcome subjectivity in assessing nausea, vomiting, and pain, we used Common Terminology Criteria for Adverse Events (CTCAE) and a visual analog scale,” the authors stated.

Of the patients in the dexamethasone group, 78% had incidences of PES, compared with 97.5% of those in the control group. After undergoing chemoembolization, patients in the dexamethasone group were hospitalized for a mean of 2.7 days ± 1.44. Patients in the control group were hospitalized for 2.9 days ± 1.83. In the dexamethasone group, there were lower mean doses of antiemetic and analgesic agents than in the control group.

The study’s limitations include its small size and location at a single center, as well as a difference in male/female ratio between the two groups, though this did not significantly affect PES occurrence.

 “In conclusion, this randomized, double-blinded, placebo-controlled study demonstrates that prophylactic dexamethasone following transarterial chemoembolization for HCC is an effective and safe way to reduce PES,” the researchers wrote.

Reference

Yang H, Seon J, Sung PS, et al. Dexamethasone prophylaxis to alleviate postembolization syndrome after transarterial chemoembolization for hepatocellular carcinoma: a randomized, double-blinded, placebo-controlled study. J Vasc Interv Radiol. 2017;28(11):1503-1511.e2.