Transarterial Chemoembolization (TACE) is a procedure used to treat liver cancer. This article explores TACE as a treatment option, focusing on how it works, typical survival outcomes, factors that influence patient prognosis, and what patients can expect regarding recovery and ongoing care.
What is TACE?
Transarterial Chemoembolization (TACE) is a minimally invasive procedure primarily used to treat hepatocellular carcinoma (HCC), the most common type of liver cancer. This treatment targets liver tumors by delivering chemotherapy drugs directly to the cancerous cells while simultaneously cutting off their blood supply.
The procedure involves an interventional radiologist inserting a catheter into an artery, typically in the groin or wrist. Guided by X-ray imaging, the catheter is advanced through the arterial system to the hepatic artery, which supplies blood to the liver. Liver tumors often receive their blood supply predominantly from the hepatic artery, while the surrounding healthy liver tissue receives most of its blood from the portal vein.
Once the catheter is positioned in the specific branches of the hepatic artery feeding the tumor, a mixture of chemotherapy drugs and an embolic agent is injected. The chemotherapy directly targets the tumor, delivering a high concentration of anti-cancer drugs without exposing the entire body to their full effects. The embolic agent, often a gelatin sponge or tiny beads, then blocks these small arteries, trapping the chemotherapy within the tumor and depriving it of oxygen and nutrients. This dual approach maximizes the treatment’s impact on the tumor while minimizing harm to healthy liver tissue.
Understanding Survival Rates
TACE is a palliative treatment that can improve patient survival for hepatocellular carcinoma (HCC), especially for those who are not candidates for surgery or ablation. Median survival times after TACE for HCC can vary, with some studies reporting a median survival of approximately 2.74 years. Other studies have shown a median overall survival ranging from 17.1 months to about 43 months depending on patient characteristics and tumor stage.
“Median survival” refers to the point at which half of the patients in a study are still alive and half have passed away. For instance, if the median survival is 2.74 years, it means that 50% of the patients treated lived for at least 2.74 years or longer. One-year survival rates after TACE can be around 80%, with three-year rates at 46% and five-year rates at 25% in some patient groups. Another study reported a one-year survival of 80% and a two-year survival of 56.6%. These statistics represent averages from large groups of patients, and individual outcomes can differ significantly based on various factors.
Factors Influencing Prognosis
Several factors significantly impact a patient’s prognosis following a TACE procedure. The characteristics of the tumor play a substantial role, including its size and number. Larger tumors or multiple tumors may require repeated TACE sessions, which can influence long-term prognosis. The stage of liver cancer is also a strong predictor of survival. Patients with earlier-stage disease typically have better outcomes compared to those with advanced stages, where the cancer may have spread or involves major blood vessels.
The patient’s overall liver function is another powerful determinant of prognosis. This is frequently assessed using scoring systems like the Child-Pugh score, which evaluates factors such as bilirubin and albumin levels, blood clotting ability, and the presence of fluid in the abdomen or effects on brain function. A Child-Pugh score classifies liver function into grades A, B, or C, with A indicating well-preserved function and C indicating severe impairment. Patients with better liver function (e.g., Child-Pugh class A or early B) generally tolerate TACE better and have more favorable survival rates. Additionally, the patient’s general health and the presence of other medical conditions also influence how well they respond to treatment and their overall prognosis. Factors such as an elevated alpha-fetoprotein (AFP) level or the presence of tumor thrombus in blood vessels can indicate a more aggressive disease and are associated with shorter survival.
Life After TACE
Patients remain hospitalized for one to two days following a TACE procedure for monitoring and management of immediate side effects. Common post-procedure symptoms include fever, nausea, vomiting, fatigue, and discomfort or pain in the abdomen. These symptoms, often referred to as post-embolization syndrome, usually resolve within one to two weeks, although fatigue may persist longer. Medications are prescribed to help manage pain and nausea during this recovery period.
Ongoing care is a regular part of life after TACE. Patients will have follow-up appointments and imaging scans, such as MRI or CT, about one month after the procedure and then every three to four months thereafter, to monitor the tumor’s response to treatment. These scans help assess if the tumor has shrunk, if the chemotherapy and embolic agents have been effectively deposited, and to detect any new or recurring lesions. The goal is to identify viable tumor tissue, which may show arterial enhancement on imaging.
Patients may require additional TACE sessions if the tumor has not fully responded or if new tumors develop. The number and frequency of these repeat treatments depend on the tumor’s response and the patient’s liver function. In some cases, TACE may be part of a broader treatment plan, combined with other therapies like surgery, ablation, or systemic medications.