Transarterial Chemoembolization (TACE): Information & TACE Specialists

Transarterial chemoembolization may be indicated in various clinical scenarios, such as when

• liver metastases cannot be surgically removed or
• the patient does not respond to systemic chemotherapy.

In order for TACE to be performed, the patient should be

• be in good general health,
• normal vascular architecture,
• an open portal vein, and
• sufficient liver function

.

It is often used in patients for whom

• the primary goal is life-prolonging (palliative) therapy due to an inoperable liver tumor, or
• the tumor is initially inoperable due to its size.

This therapy often succeeds in shrinking the tumors to the point where resection (removal) of the affected tissue is possible.

Another area of application for TACE is what is known as a “bridge to transplantation.” Many patients require a donor liver for a liver transplant but are on a long waiting list. This therapy allows them to bridge the waiting period by inhibiting further tumor growth.

This can help keep the patient in a condition suitable for surgery until a donor organ is found and allocated.

The potential patient population for transarterial chemoembolization can therefore be divided into:

• Patients in whom the goal is to reduce the size of inoperable tumors,
• Patients for whom systemic chemotherapy is not effective,
• Patients awaiting a donor liver,
• Patients for whom palliative therapy is the primary goal.

In chemoembolization, a chemotherapeutic agent is delivered directly into a tumor via a catheter. This blocks the surrounding blood vessels. The procedure is monitored using angiography, a real-time imaging technique. This is intended to limit the effect of the chemotherapy to the local area, thereby minimizing the impact on the rest of the body.

This form of therapy is used primarily for liver tumors with a rich blood supply.

Hepatocellular carcinoma (primary liver cancer) receives its blood supply primarily through the hepatic artery. This is also the case for other tumors and metastases in the liver. Normal liver tissue, on the other hand, is supplied mainly by the portal vein. This is where transarterial chemoembolization comes into play.

Before the actual TACE treatment, a detailed treatment plan is developed. Imaging techniques are used to precisely locate the tumor tissue.

During the procedure, a catheter is guided under local anesthesia through the femoral artery directly to the tumor. Through this catheter, targeted anticancer drugs are administered, and embolization is performed simultaneously.

Put simply, this means that the tumor’s blood supply is cut off by blocking the blood vessels. This also allows the medication to remain in the tumor longer and, due to its local action, at a higher dose, thereby achieving the desired effect.

In addition to the medication itself, a contrast agent is used. This allows the doctor to monitor the nature of the tumor and the position of the catheter.

This image shows the administration of medication via a catheter into the liver’s vascular system © samunella | AdobeStock

The choice of medication is determined on a case-by-case basis. Chemotherapeutic agents used include, among others, drugs such as

• doxorubicin,
• carboplatin, and
• mitomycin C.

Lipiodol (iodine-containing oil) is also used as part of the embolization procedure.

After the procedure, a pressure bandage is applied to the patient. During a six-hour monitoring period, the patient’s pulse and blood pressure are monitored. After 24 to 48 hours, the treatment outcome is re-evaluated with a CT scan without contrast.

TACE treatment is typically repeated 2 to 3 more times at 4-week intervals.

How often the therapy is repeated depends on the individual treatment goals and the success of the therapy. In some cases,

• embolization without chemotherapy (transarterial embolization—TAE)
• local chemotherapy without embolization (chemoperfusion)

may also be performed.

One advantage of transarterial chemoembolization is that it is a minimally invasive procedure that is performed on an outpatient or day-surgery basis.

The surrounding tissue is largely spared thanks to small incisions and the targeted limitation of the drug’s effect. Since the drugs are delivered directly into the tumor, the burden on the entire body remains relatively low.

Conventional chemotherapy, on the other hand, often affects not only the diseased tissue but also healthy tissue and organs. These side effects do not occur with transarterial chemoembolization.

Serious complications or side effects are relatively rare with this treatment method.

Prior to the procedure, a detailed consultation with the patient takes place to identify and minimize potential risks. These include, for example, allergies to certain medications.

Bleeding may occur at the puncture site after the procedure. For this reason, a pressure bandage is applied to the patient after the procedure. In addition, bed rest for several hours is recommended.

In some cases, a condition known as post-embolization syndrome may occur, which can cause

• nausea,
• joint pain, or
• excessive sweating

. However, this is a normal reaction of the body and is generally not a cause for concern.

• Allergies to medications
• Post-procedure bleeding at the puncture site
• Post-embolization syndrome