Transarterial Chemoembolization [TACE] is a minimally invasive treatment for liver cancer, in which small particles are soaked with chemotherapy and then injected directly into the liver cancer. It is the most widely used treatment for unresectable hepatocellular cancer [HCC]. It is also used for the treatment of metastatic liver cancers.
What is the rationale for Transarterial Chemoembolization [TACE]?
Some liver cancers have genetic mutations that can cause an over-expression of abnormal blood supply. Liver cancers are supplied mainly by the hepatic artery. The normal liver has two blood supply. The blood supply to the tumor is blocked while the blood supply to the normal liver is spared. The TACE cocktail is able to kill and shrink the liver cancer and there is little damage to the normal liver.
How do I perform a Transarterial Chemoembolization [TACE] procedure?
I perform the TACE procedure in the Angiography Suite using X-ray guidance. The artery in the wrist or groin is punctured and a catheter is advanced to the liver. Contrast material is injected into the artery to identify the arterial feeders that support the tumor. A mixture of a suitable chemotherapeutic agent and microspheres particles are injected directly into the liver cancer. The end result is the death of the liver tumor.
Can Transarterial Chemoembolization [TACE] cure liver cancer?
Liver cancer, like other cancers, is caused by genetic mutations. The cancers can occur due to repeated insults to the liver or due to the spread of cancer from other organs to the liver. Whether the cancer is removed by surgery or liver transplantation or treated with Embolization or Ablation (burnt or frozen), cancers have the ability to return.
Types of liver cancers treated with Transarterial Chemoembolization [TACE]?
The cancers that arise from the liver are hepatocellular cancer and cholangiocarcinoma. The cancers that spread to the liver from other organs are called metastatic liver cancers. Patients with liver cancer can be treated if they can tolerate the treatment. Therefore a patient’s overall health status, liver function, size, and characteristics of cancer is evaluated before offering treatment.
What are the survival benefits for Transarterial Chemoembolization [TACE]?
TACE is the standard of care for intermediate-stage hepatocellular carcinoma [HCC]. TACE increases survival in appropriately chosen patients. In such patients, the median survival after TACE is 40–50 months.
What are the side effects of Transarterial Chemoembolization [TACE]?
The most common side effects are liver enzyme abnormalities, fever, pain, and vomiting. These side effects can be managed with analgesics, steroids, and antiemetics drugs.
The ideal patient for Transarterial Chemoembolization [TACE] procedure?
In choosing patients for TACE, we consider tumor burden, underlying liver disease, and performance status. Patients with declining performance status or severe liver dysfunction are not likely to benefit from TACE.
What is the Follow up after Transarterial Chemoembolization [TACE]?
After a TACE procedure, a follow-up CT scan or MRI scan is done after 6 weeks and then at regular intervals every 3 months, 6 months or 1 year. This is used to monitor response, recurrence, or progression. After initial TACE success, new tumors can arise and the treated tumors can regain blood supply and thus TACE may be repeated.
Combination of Transarterial Chemoembolization [TACE] and Thermal Ablation?
Thermal ablation is the use of heat or ice to kill tumors and this technology can be used in the liver. In some patients, the combination of TACE and Thermal Ablation is associated with significantly higher overall survival, without a significant difference in major complications.
Combination of Transarterial Chemoembolization [TACE] and antiangiogenics?
The combination of TACE with anti-angiogenic agents might improve outcomes. Sorafenib is one of the biological agents that block the vascular endothelial growth factor receptor receptors to treat hepatocellular cancers.
Other reasons for Transarterial Chemoembolization [TACE]?
TACE is also used in patients with hepatocellular cancer [HCC ] while a patient is waiting for liver transplantation, hepatic resection, and image-guided ablation.
TACE is a minimally invasive treatment of liver cancer. It is a same-day treatment with minimal side effects. It has been shown to improve overall survival when used alone or in combination with ablation or angiogenesis blocker drugs in appropriate patients.