Transarterial Chemoembolization

• Transarterial Chemoembolization (TACE) is a minimally invasive treatment for liver cancer.
• It involves delivering high-dose chemotherapy directly to liver tumors.
• Following chemotherapy delivery, the blood vessels supplying the tumor are blocked (embolized).
• TACE aims to deprive the tumor of blood flow and nutrients while exposing it to anticancer drugs.
• It is often used for unresectable liver cancers or as a bridge to other treatments like transplantation.

What is Transarterial Chemoembolization (TACE)?

Transarterial Chemoembolization (TACE) is a sophisticated, minimally invasive procedure designed to treat primary liver cancer (hepatocellular carcinoma, or HCC) and sometimes metastatic tumors in the liver. This technique involves the selective delivery of chemotherapy agents directly into the arteries that supply blood to the liver tumor. By targeting the tumor’s blood supply, TACE maximizes the concentration of chemotherapy drugs within the cancerous cells while minimizing systemic exposure and potential side effects to healthy tissues throughout the body.

Following the administration of chemotherapy, an embolic agent is introduced to block these same arteries. This dual approach not only delivers a potent dose of anticancer medication but also cuts off the tumor’s vital blood supply, starving it of oxygen and nutrients. TACE is typically performed by interventional radiologists and is considered a regional therapy, meaning its effects are localized to the liver.

How Transarterial Chemoembolization Works

The Transarterial Chemoembolization procedure begins with a small incision, usually in the groin, to access the femoral artery. A thin, flexible tube called a catheter is then guided through the arterial system, under real-time imaging (fluoroscopy), until it reaches the hepatic artery, which supplies blood to the liver. The interventional radiologist carefully navigates the catheter further into the smaller arteries that specifically feed the liver tumor.

Once the catheter is precisely positioned, a concentrated dose of chemotherapy drugs, often mixed with an oily substance (lipiodol) to help it stay in the tumor longer, is injected. This ensures that the cancerous cells receive a very high dose of medication. Immediately after the chemotherapy infusion, embolic agents—which can be tiny particles, beads, or gels—are injected through the catheter. These agents block the blood flow to the tumor, effectively trapping the chemotherapy within the tumor and depriving it of its blood supply. This combined action leads to tumor cell death and shrinkage.

• Targeted Drug Delivery: Chemotherapy is delivered directly to the tumor, sparing healthy liver tissue and reducing systemic side effects.
• Ischemia Induction: Embolization cuts off the tumor’s blood supply, leading to oxygen and nutrient deprivation, which further damages cancer cells.
• Sustained Exposure: The embolic agents help to keep the chemotherapy drugs concentrated in the tumor for an extended period, enhancing their effectiveness.

TACE Treatment for Liver Cancer

TACE treatment for liver cancer is a well-established therapy, particularly for patients with unresectable hepatocellular carcinoma (HCC), which is the most common type of primary liver cancer. Hepatocellular carcinoma accounts for 75-85% of all primary liver cancers, making it a significant global health challenge, according to the World Health Organization (WHO). TACE is often used when surgical removal of the tumor is not possible due to the tumor’s size, location, or the patient’s overall health.

This treatment can serve several purposes: it can shrink tumors to make them eligible for surgery or transplantation (known as “downstaging” or “bridging therapy”), control tumor growth, alleviate symptoms, and extend life expectancy. Patients typically undergo TACE multiple times, with treatment sessions spaced several weeks or months apart, depending on their response and tolerance to the procedure. Close monitoring through imaging studies and blood tests is essential to assess the treatment’s effectiveness and manage any potential complications.