Transarterial chemoembolization, or TACE, is a minimally invasive treatment primarily used for liver cancer. This localized therapy combines two methods: delivering cancer-fighting drugs directly to a tumor and blocking its blood supply. Performed by an interventional radiologist using imaging guidance, the goal is to trap a high concentration of chemotherapy at the site while cutting off the nutrients and oxygen the tumor needs to grow.
Purpose of TACE Treatment
TACE is most frequently used for hepatocellular carcinoma (HCC), the most common type of primary liver cancer, and for liver metastases from other parts of the body. The treatment is for tumors that cannot be removed with surgery, a status known as unresectable. For these patients, TACE serves as a palliative measure, with the goal of slowing tumor progression and extending survival rather than curing the cancer.
This procedure can also act as a bridge to a liver transplant. By controlling tumor growth, TACE can keep a patient’s cancer within the criteria required for a transplant while they await a donor organ. It may be used with other treatments like ablation, radiation therapy, or systemic chemotherapy. The liver’s unique blood supply makes TACE possible; normal liver tissue is fed by the portal vein, while tumors are fed by the hepatic artery, allowing doctors to block the tumor’s supply without significantly harming healthy liver.
Patient Eligibility and Preparation
Determining a patient’s suitability for TACE involves evaluating several factors. The number, size, and location of the liver tumors are assessed, as the procedure is most effective when the cancer is confined to the liver. A patient’s overall liver function is another consideration; because the treatment alters blood flow, the liver must be healthy enough to withstand it. Doctors perform blood tests to check liver and kidney function before recommending TACE.
The condition of the portal vein, the main blood vessel supplying the liver, is also assessed. A significant blockage in this vein can make the procedure too risky, as healthy liver tissue depends on this blood supply. Before the treatment, patients undergo imaging studies, such as a CT scan or MRI, to map the liver’s blood vessels and pinpoint the arteries feeding the tumors. Patients are given instructions, which include fasting for several hours and adjusting their medication schedule.
The TACE Procedure Explained
The TACE procedure is performed in an interventional radiology suite. It delivers a high dose of chemotherapy directly to the tumor and simultaneously obstructs the arterial blood flow that feeds it. This dual approach traps the cancer-fighting drugs within the tumor, maximizing their impact while minimizing the systemic side effects common with traditional chemotherapy. The entire process takes about two hours to complete.
For the procedure, the patient receives moderate sedation, though general anesthesia may be used. The interventional radiologist begins by numbing a small area of skin in the groin and making a tiny incision to access the femoral artery. Using X-ray guidance, known as fluoroscopy, the radiologist threads a thin, flexible tube called a catheter through the artery and navigates it into the hepatic artery, which supplies blood to the liver.
Once the catheter is in position, a contrast dye is injected, making the liver’s blood vessels visible on X-ray images. This allows the radiologist to identify the specific arterial branches feeding the tumor. The catheter is then advanced into these targeted vessels. A mixture of chemotherapy drugs and an embolic agent—often tiny plastic beads or a gelatin sponge—is injected into these arteries. The embolic agent cuts off the blood supply, holding the chemotherapy in place, and after the injection, the catheter is withdrawn and pressure is applied to the incision site.
Recovery and Potential Side Effects
Following the TACE procedure, patients are monitored in the hospital, often for an overnight stay, to manage any immediate side effects. The recovery period varies, but most people can return to their normal activities within one to three weeks. Strenuous activity should be avoided for about 10 days.
A common reaction after TACE is post-embolization syndrome. This is an expected group of symptoms that includes fever, abdominal pain, and nausea or vomiting. These symptoms occur as the tumor tissue breaks down and are managed with medications for pain and nausea. More serious complications are rare but can include infection, bleeding at the catheter insertion site, or unintended damage to blood vessels or healthy liver tissue.
Treatment Goals and Efficacy
The primary goal of TACE is to control liver tumors, not necessarily to eliminate them. Success is measured by how well the treatment slows tumor growth or causes tumors to shrink. Doctors monitor effectiveness through follow-up imaging scans, like CT or MRI, performed several weeks or months after treatment to assess the tumor’s response.
In many cases, TACE is not a one-time treatment. The procedure may need to be repeated if the original tumors begin to grow again or if new tumors appear in the liver. Studies show that TACE can successfully halt tumor growth in a significant percentage of patients, with some reports indicating a success rate of around 70%. By managing the cancer’s progression, the treatment can help extend a patient’s life and maintain their quality of life.