Transarterial Chemoembolization (TACE)

What Does Chemoembolization Mean?

Chemoembolization is a minimally invasive procedure to cut off malignant tumors or metastases of the liver or lung from the blood supply and to be able to apply a chemotherapeutic agent in a targeted manner at the same time. The principle involves injecting the drug directly into the tumor area with a catheter and then closing (embolizing) the blood vessels supplying the tumor.

Which Cancers Can Be Treated With TACE?

Transarterial chemoembolization is a therapy for treating liver cancer and liver metastases from other cancers. It can also be applied to lung tumors.

It is used when surgery or chemotherapy is not possible or has already been carried out unsuccessfully. On the other hand, chemoembolization is not possible if tumors are present in the entire liver or outside of it. Heart and liver failure, an allergy to contrast media, and blood clotting disorders are also exclusion criteria for this type of treatment.

The advantage of chemoembolization is that it is gentler than conventional therapies. The procedure requires only a tiny incision to access the blood vessels. Also, only a minimal area is exposed to the aggressive chemotherapeutic agent.

The Procedure of Transarterial Chemoembolization

If the treating oncologist has indicated for the intervention, chemoembolization is carried out during a short inpatient stay. Before the procedure, the patient is informed, a medical history is taken, and the liver function is checked. Subsequently, CT or MRI of the abdomen is performed to exclude the possibility of metastases or tumors having formed outside the liver.

For the chemoembolization, a groin artery is punctured under local anesthesia, and a catheter is inserted containing the drug and the embolus. In addition, the practitioner injects the patient with a contrast agent that allows the blood vessels to be visualized so that the catheter can be placed under visual monitoring by X-ray at the exact desired location in the artery supplying the tumor. Then the substances in the catheter are released. The drug can act precisely in the tumor region. At the same time, the embolization cuts off the supply of nutrients and oxygen.

After the treatment, a pressure bandage is applied to the puncture site, and the patient should stay in bed for about 5 hours. A short hospital stay of 1 or 2 days is necessary to detect and treat possible side effects.

Since a single embolization is not sufficient, the procedure is repeated four to eight times at four to eight weeks intervals.

What Are the Side Effects?

Since chemoembolization is a minimally invasive procedure, side effects and complications are rare but possible. Worth mentioning are post-embolization bleeding from the injection site and post-embolization syndrome with pain and fever. Besides, the embolus can enter blood vessels other than the desired ones, which in the worst case, can lead to inflammation of the gallbladder and stomach ulcers. All of these complications can be treated well.

What Are the Expectations After TACE?

Chemoembolization usually cannot cure cancer completely. However, it does serve to slow down the disease's progression and improve the patient's quality of life. Studies show a significantly better 2-year survival rate.

Besides, this form of treatment can reduce the size of a tumor to such an extent that surgical removal is possible. Chemoembolization is also of importance for people waiting for a liver transplant since it slows down the disease.

Sources:

radiologie-uni-frankfurt.de