Transarterial chemoembolisation therapy (TACE) is a localized method of administrating chemotherapy directly to a liver tumor via a catheter study. The chemoembolic agent may be delivered via a mixture with LipiodolⓇ, known as conventional TACE, or as an injection of drug-eluting beads (DEB-TACE) 6.
Transarterial embolization (TAE) (i.e. without a chemotherapy agent added) is also used, and there is evidence that this may be just as effective as TACE 1.
It can be used as palliative treatment for a patient with unresectable HCC (usually BCLC stage B) or as a bridge to a liver transplant. It may sometimes also be performed prior to radiofrequency tumor ablation.
- extensive tumor infiltration throughout the liver
- large burden of extra-hepatic metastases
- portal vein thrombosis
- liver or renal failure
- uncorrectable coagulopathy
- significant arteriovenous shunting of blood through the tumor
Chemoembolic particles are used to occlude hepatic arterial supply to the tumor with resultant necrosis. There is wide variability in the type of embolization particles and chemotherapy, as well as timing 1.
TACE has been shown to have a survival benefit over current treatments as well as reducing patient symptoms and preventing tumor growth 1,2.
CT is typically used for follow up imaging, with the oily based embolic particles having a distinct high attenuation appearance.
One key advantage is the chemotherapy is targeted locally so reducing the systemic side effects of intravenous chemotherapy.
Response to treatment
Imaging is generally advised after 3-4 weeks, either triple phase CT, dynamic MRI or contrast enhanced USG. The accumulation pattern of the iodised oil and enhancement pattern of the mass is to be observed to evaluate the response to the treatment. The more the accumulation greater the necrosis and, thus, the survival. Enhancing areas of tumor are considered as residual viable tumor 5.
There are four types of patterns that have been described:
- homogeneous accumulation of iodised oil in the whole tumor and the surrounding area. This type of accumulation indicates good response to treatment
- homogeneous accumulation of iodised oil in the tumor only
- irregular accumulation with filling defects. This accumulation represents less than optimal
- no accumulation/retention of iodised oil
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- 5. Kawaguchi T, Ohkawa K, Imanaka K et-al. Lipiodol accumulation and transarterial chemoembolization efficacy for HCC patients. Hepatogastroenterology. 2011;59 (113): 219-23. doi:10.5754/hge11258 - Pubmed citation
- 6. Salem R, Lewandowski RJ. Chemoembolization and radioembolization for hepatocellular carcinoma. (2013) Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 11 (6): 604-11; quiz e43-4. doi:10.1016/j.cgh.2012.12.039 - Pubmed