ArticleTranslational cancer research2026
Dexamethasone and N-acetylcysteine for the prevention of post-embolization syndrome following transarterial chemoembolization in hepatocellular carcinoma: a systematic review and network meta-analysis.
Article in Translational cancer research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Post-embolization syndrome (PES), characterized by fever, pain, nausea, and vomiting, is a common complication following transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Dexamethasone (DEXA) and N-acetylcysteine (NAC) have been evaluated as monotherapy and in combination for PES prophylaxis, but their comparative efficacy remains uncertain. This study aims to compare the efficacy and safety of DEXA, NAC, and their combination in preventing PES after TACE. Methods: We conducted a Bayesian network meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, Embase, and the Cochrane Library up to November 2025. RCTs assessing prophylactic DEXA, NAC, their combination, or placebo in patients with HCC undergoing TACE were included. The primary outcome was the incidence of PES, and secondary outcomes were individual symptoms, including pain, fever, nausea, and vomiting. Risk ratios (RRs) with 95% credible intervals (CrIs) and surface under the cumulative ranking curve (SUCRA) values were calculated. Results: Eight RCTs involving 667 patients were included. The network meta-analysis demonstrated that, compared with placebo, DEXA combined with NAC significantly reduced the incidence of PES (RR =0.11, 95% CrI: 0.018-0.69) and ranked highest (SUCRA 96.1%). Combination therapy also showed significant benefits over placebo and favorable trends compared with monotherapy in reducing the risks of pain, fever, nausea, and vomiting. DEXA was associated with manageable adverse events such as hyperglycemia, whereas NAC exhibited a favorable safety profile. Conclusions: Prophylactic administration of DEXA combined with NAC appears to be the most effective approach among the regimens studied for preventing PES and its related symptoms after TACE for HCC. Future studies should validate these findings in broader populations and explore optimal dosing duration and predictive biomarkers.
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