Transarterial chemoembolisation therapy (TACE) is a localised method of administrating chemotherapy directly to a liver tumour via a catheter study.
Transarterial embolisation (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 tumour ablation.
- extensive tumour 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 tumour
Chemoembolic particles are used to occlude hepatic arterial supply to the tumour with resultant necrosis. There is wide variability in the type of embolisation 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 tumour 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 tumour are considered as residual viable tumour 5.
There are four types of patterns that have been described:
- homogeneous accumulation of iodised oil in the whole tumour and the surrounding area. This type of accumulation indicates good response to treatment
- homogeneous accumulation of iodised oil in the tumour only
- irregular accumulation with filling defects. This accumulation represents less than optimal
- no accumulation/retention of iodised oil
- 1. Tsochatzis EA, Fatourou E, O'Beirne J et-al. Transarterial chemoembolization and bland embolization for hepatocellular carcinoma. World J. Gastroenterol. 2014;20 (12): 3069-77. doi:10.3748/wjg.v20.i12.3069 - Free text at pubmed - Pubmed citation
- 2. Wáng YX, De Baere T, Idée JM et-al. Transcatheter embolization therapy in liver cancer: an update of clinical evidences. Chin. J. Cancer Res. 2015;27 (2): 96-121. doi:10.3978/j.issn.1000-9604.2015.03.03 - Free text at pubmed - Pubmed citation
- 3. Lewandowski RJ, Geschwind JF, Liapi E et-al. Transcatheter intraarterial therapies: rationale and overview. Radiology. 2011;259 (3): 641-57. doi:10.1148/radiol.11081489 - Free text at pubmed - Pubmed citation
- 4. Jazieh KA, Arabi M, Khankan AA. Transarterial therapy: an evolving treatment modality of hepatocellular carcinoma. Saudi J Gastroenterol. 2014;20 (6): 333-41. doi:10.4103/1319-3767.145315 - Free text at pubmed - Pubmed citation
- 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