Transarterial chemoembolization is a minimally invasive radiological treatment method for
In this procedure, chemotherapeutic drugs are introduced into the liver tissue via the hepatic arteries (transarterially) and thus into the tumor. In this way, high doses of active substances can be achieved locally .
Embolization (planned vascular occlusion) of the hepatic arteries cuts off the blood supply to the tumour while sparing the healthy liver tissue. These combined procedures ensure that the chemotherapeutic agent remains effective in the tumor area of the liver for longer.
The TACE procedure means
- less stress for the patient,
- slower tumor growth or even its regression and
- an overall shorter hospital stay compared to surgery.
TACE treatment is carried out under local anesthesia and is usually performed on an outpatient or day-care basis.
The anatomy of the liver © Henrie | AdobeStock
Transarterial chemoembolization can be indicated for various disease processes, for example when
- liver metastases cannot be surgically removed or
- the patient does not respond to systemic chemotherapy.
In order for TACE to be carried out, the patient should have
- a good general condition,
- normal vascular architecture,
- an open portal vein and
- adequate liver function.
liver function.
It is often used in patients for whom
- the focus is on life-prolonging (palliative) therapy due to an inoperable liver tumor or
- the tumor is initially inoperable due to its size.
The therapy often succeeds in shrinking the tumors to such an extent that resection (removal) of the affected tissue is possible.
Another area of application for TACE is the so-called bridge to transplantation. Many patients require a donor liver for liver transplantation but are on a long waiting list. They can bridge the waiting time with the help of the therapy, as the tumor is hindered in its further growth.
This can help to keep the patient fit for surgery until the donor organ is found and allocated.
The possible patient group for transarterial chemoembolization can therefore be divided into
- Patients for whom the aim is to reduce the size of inoperable tumors,
- Patients for whom systemic chemotherapy is not effective,
- Patients waiting for a donor liver,
- Patients for whom palliative therapy is a priority.
In chemoembolization, a chemotherapeutic agent is introduced into a tumour through a catheter. This closes off the surrounding blood vessels. The process is monitored in real time using angiography, an imaging procedure. This is intended to limit the effect of the chemotherapy locally and thus protect the entire organism.
This form of therapy is primarily used for liver tumors with a high 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 mainly supplied by the portal vein. This is where transarterial chemoembolization comes in.
A precise treatment plan is drawn up before the actual TACE treatment. Imaging procedures are used to precisely determine the tumor tissue.
During the procedure, a catheter is inserted directly into the tumor via thefemoral artery under local anesthesia. This catheter is used to administer targeted medication to combat the tumour and embolization is carried out at the same time.
In simple terms, this means that the tumor's supply of blood is cut off by a vascular occlusion. This also allows the drug to remain in the tumor for longer and with a higher dose due to the local mode of action, thus achieving the desired effect.
In addition to the drug 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 vascular system of the liver © samunella | AdobeStock
The drug to be used is decided on an individual basis. The chemotherapeutic agents used include preparations such as
- doxorubicin,
- carboplatin or also
- mitomycin C.
Lipiodol (iodine-containing oil) is also used during embolization.
After the procedure, the patient is given a pressure bandage. During a six-hour monitoring phase, the patient's pulse and blood pressure are monitored. After 24 to 48 hours, the treatment result is checked again using CT without contrast medium.
The TACE treatment is normally repeated 2 to 3 more times at intervals of 4 weeks.
How often the treatment is repeated depends on the individual goals and the success of the treatment. In some cases
- embolization without chemotherapy (transarterial embolization - TAE)
- local chemotherapy without embolization (chemoperfusion)
is carried out.
One advantage of transarterial chemoembolization is that it is a minimally invasive procedure that is performed on an outpatient or day-care basis.
The surrounding tissue is largely spared thanks to small incisions and a targeted limitation of the drug effect. As the medication is administered directly into the tumor, the impact on the entire organism remains relatively low.
Conventional chemotherapies, on the other hand, often affect not only the altered tissue, but also healthy tissue and organs. These side effects do not occur with transarterial chemoembolization.
Serious complications or side effects are rare with this treatment method.
Prior to the procedure, a detailed discussion is held with the patient in order to identify and minimize possible 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. Bed rest for several hours is also recommended.
In some cases, so-called post-embolization syndrome can occur, which can lead to
- nausea,
- joint pain or
- increased sweating
occurs. However, this is a normal reaction of the body and is not usually a cause for concern.
- Allergies to medication
- Postoperative bleeding at the puncture site
- Post-embolization syndrome
