Transarterial Chemo-embolisation of liver tumours (TACE)

Transarterial chemoembolization (TACE) is a minimally invasive procedure used primarily to treat liver cancer, including hepatocellular carcinoma (HCC) and metastatic liver cancers. TACE combines localized chemotherapy delivery with embolization, which blocks the blood supply to the tumor. This dual approach enhances the effectiveness of chemotherapy while depriving the tumor of the nutrients it needs to grow.

Here’s a detailed overview of the TACE procedure:

Procedure Overview

1. Pre-procedure Evaluation:
   • Imaging: MRI or CT scans to evaluate the liver and tumor.
   • Blood Tests: To assess liver function and overall health.
   • Angiography: To map the blood supply to the liver and tumor.
2. Preparation:
   • Catheter Insertion: A catheter is inserted through a small incision, typically in the groin, and guided through the arterial system to the hepatic artery that supplies the liver tumor.
3. Chemotherapy Delivery:
   • Chemo Drug Injection: Chemotherapeutic agents are injected directly into the hepatic artery.
   • Embolic Agents: Tiny particles or beads are also injected to block the artery, trapping the chemotherapy within the tumor and cutting off its blood supply.
4. Embolization:
   • The embolic agents cause ischemia, leading to tumor cell death due to lack of oxygen and nutrients.

Benefits

• Targeted Therapy: Delivers high concentrations of chemotherapy directly to the tumor with minimal systemic exposure.
• Dual Action: Combines chemotherapy with embolization, enhancing the treatment’s efficacy.
• Minimally Invasive: Less invasive than traditional surgery with shorter recovery times.

Indications

• Primary Liver Cancer: Such as hepatocellular carcinoma (HCC), particularly in patients who are not candidates for surgery. (Click here to read more on Hepatocellular Carcinoma)
• Secondary Liver Cancer: For tumors that have metastasized to the liver from other primary sites like colorectal cancer.
• Bridging Therapy: Used to control tumor growth in patients awaiting liver transplantation.

Risks and Considerations

• Post-embolization Syndrome: Common side effects include pain, fever, nausea, and fatigue.
• Liver Damage: Potential for liver function deterioration, especially in patients with pre-existing liver disease.
• Non-target Embolization: Risk of embolic agents affecting non-target tissues, leading to complications.
• Infection: Potential for infection at the catheter insertion site or within the liver.

Post-Procedure Care

• Monitoring: Regular follow-up with imaging to evaluate the response to treatment.
• Symptom Management: Medications to manage pain, fever, and other side effects.
• Liver Function Tests: Ongoing assessment of liver function through blood tests.

Comparison with Other Treatments

• TACE vs. TARE: Both TACE and transarterial radioembolization (TARE) are used to treat liver cancer, but they differ in their approach. TACE delivers chemotherapy directly to the tumor and uses embolization to block blood flow, while TARE uses radioactive microspheres to deliver targeted radiation therapy. (Click here to read more on Transarterial Radio-embolisation of liver tumours (TARE))
• TACE vs. Systemic Chemotherapy: TACE provides a more localized treatment with fewer systemic side effects compared to traditional systemic chemotherapy.

TACE is a valuable treatment option for patients with liver cancer, offering a targeted approach to chemotherapy that can effectively control tumor growth and improve survival rates. However, careful patient selection and post-procedure monitoring are crucial to managing potential risks and maximizing the benefits of the treatment.