Nitroglycerine use in transcatheter arterial (chemo) embolization in patients with hepatocellular carcinoma: Five-year retrospective study

Background: Addition of nitroglycerine (NTG) to transcatheter arterial embolization/transarterial chemoembolization (TAE/TACE) has been shown to increase deposition of Lipiodol emulsion in hepatocellular carcinoma (HCC) tumors. The aim of this retrospective study was to evaluate if the addition of nitroglycerin (NTG) to TAE/TACE improved treatment response in HCC. Methods: Patients with HCC either received (n = 42) or did not receive (non-NTG) (n = 111) NTG and an emulsion of Lipiodol with or without doxorubicin, followed by embolization with Gelfoam pledgets. Treatment response was monitored using dual-energy computer tomography (CT). Disease progression and overall survival (OS) were monitored. Results: The rate of disease progression in the NTG group was 86.5% and in the non-NTG group was 88.6%. Median time to disease progression was 12 months (95% CI; 9.0, 15.0) for the NTG group and 12 months (95% CI; 10.4, 13.6) for the non-NTG groups (P = 0.040). No difference was observed in OS between the NTG (60 months) and the non-NTG groups (41 months) (P = 0.117). Multivariate analysis found that in the NTG group, OS was associated with Cancer of the Liver Italian Program (CLIP) stage I and Barcelona Clinic Liver Cancer (BCLC) stage B. Conclusions: Addition of NTG to TAE/TACE did not result in improved OS or disease progression.