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Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2017/07  
 
  2017 Jul  
  doi: 10.1002/hep.29403.  
 
  A Randomized Placebo-Controlled Trial of Prophylactic Dexamethasone for Transcatheter Arterial Chemoembolization  
 
  Ogasawara S, Chiba T, Ooka Y, Kanogawa N, Motoyama T, Suzuki E, Tawada A, Nagai K, Nakagawa T, Sugawara T, Hanaoka H, Kanai F, Yokosuka O  
  https://www.ncbi.nlm.nih.gov/pubmed/28746788  
 
 

Abstract

This randomized, double-blind, placebo-controlled trial evaluated dexamethasone efficacy at preventing fever, anorexia, and nausea/vomiting, the most frequent adverse events of transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Child-Pugh class A/B patients with HCC and no macrovascular invasion/extrahepatic metastases were randomly assigned to either a dexamethasone regimen (day 1, intravenous dexamethasone [20 mg] and granisetron [3 mg] before TACE; days 2 and 3, intravenous dexamethasone [8 mg]) or a control regimen (day 1, intravenous placebo [saline] and granisetron [3 mg]; days 2 and 3, intravenous placebo). The primary endpoint was complete response, defined as the absence of grade ≥1 fever, anorexia, or nausea/vomiting according to the Common Terminology Criteria for Adverse Events (version 4.0) and no use of rescue therapy for 120 hours after TACE. A total of 120 patients between October 2010 and June 2013 were randomly assigned to treatment groups. Overall the complete response rate was greater with the dexamethasone regimen than with the control regimen (47.5%, 95% confidence interval 34.3%-60.9%, versus 10.2%, 95% confidence interval 3.8%-20.8%; P < 0.001). Cumulative incidences of fever, anorexia, and nausea/vomiting were higher in the control regimen group compared with the dexamethasone group (P < 0.001, P < 0.001, and P = 0.095, respectively). The dexamethasone regimen was generally well tolerated by HCC patients including those with well-controlled diabetes mellitus and those with hepatitis B virus infection.

CONCLUSION:

The dexamethasone regimen was more effective than the control regimen at preventing TACE-induced fever, anorexia, and nausea/vomiting in patients with HCC. (Hepatology 2017).

 

 
Question posée
 
Evaluation de l’efficacité de la dexamethasone associée ou non au granisetron (Kytril) dans la prévention du syndrome post embolisation (fièvre, anorexie, nausées/vomissements) des patients (Child A/B) ayant une chimioembolisation (TACE) pour CHC à partir d’une étude prospective randomisée en double aveugle.
 
Question posée
 
La dexamethasone administrée en IV avant la TACE (20mg) puis à 8 mg à J2 et J3 et associée au granisetron diminue significativement le syndrome post-embolisation avec une bonne tolérance.
 
Commentaires

Prouve l’efficacité de la dexaméthasone, conforte ceux qui l’utilisaient déjà pour les TACE lipiodolée non sélective, pour les autres… à réfléchir surtout chez les patients ayant une « charge » tumorale élevée ?

 
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