What is Transarterial Chemoembolization (TACE)?
Transarterial chemoembolization (TACE) is a minimally invasive procedure used primarily to treat liver cancer, also known as hepatocellular carcinoma (HCC). It involves the delivery of chemotherapy drugs directly into the blood vessels feeding a cancerous tumor, followed by the injection of embolizing agents to block these vessels. This dual approach aims to both deliver high concentrations of chemotherapy to the tumor and restrict its blood supply, causing the cancer cells to die.
1. Localized Chemotherapy Delivery: Chemotherapy drugs are administered directly into the artery supplying the tumor. This ensures that a high concentration of the drugs reaches the cancerous cells, maximizing the therapeutic effect while minimizing systemic exposure and side effects.
2. Embolization: Small particles, such as beads or gel, are injected to block the blood vessels feeding the tumor. This cuts off the blood supply, leading to oxygen and nutrient deprivation, which causes tumor cell death.
When is TACE used?
TACE is most commonly used in the treatment of primary liver cancer (HCC). It is often considered for patients who:
- Are ineligible for surgical resection or liver transplantation.
- Have tumors that are too large or too numerous to be treated with ablation.
- Have intermediate-stage HCC according to the Barcelona Clinic Liver Cancer (BCLC) staging system.
TACE may also be used for treating metastatic liver cancer and, in some cases, for cancers of other organs where traditional systemic chemotherapy has not been effective.
- Targeted Treatment: It provides high concentrations of chemotherapy directly to the tumor while sparing most of the surrounding healthy tissue.
- Minimally Invasive: As a catheter-based procedure, TACE is less invasive than open surgery and generally has a shorter recovery time.
- Palliative and Curative Potential: TACE can be used to shrink tumors, making them operable, or to alleviate symptoms and improve quality of life in cases where a cure is not possible.
- Post-embolization Syndrome: This is characterized by pain, fever, nausea, and fatigue, and occurs in a majority of patients following the procedure.
- Liver Function Deterioration: In some cases, TACE can lead to a decline in liver function, particularly in patients with pre-existing liver disease.
- Infection: There is a risk of infection at the catheter insertion site or within the liver itself.
- Non-target Embolization: Accidental embolization of non-cancerous tissue can occur, leading to unintended damage.
1. Catheter Insertion: A small catheter is inserted through a tiny incision in the groin or wrist and navigated through the blood vessels to the artery supplying the tumor.
2. Drug Delivery: Chemotherapy drugs are delivered directly to the tumor via the catheter.
3. Embolization: Embolizing agents are then injected to block the artery, cutting off the tumor's blood supply.
4. Monitoring and Recovery: The patient is monitored for a few hours to ensure there are no immediate complications and is usually discharged within a day or two.
Who performs TACE?
TACE is typically performed by an
interventional radiologist, a specialist in minimally invasive, image-guided procedures. The interventional radiologist works closely with the oncology team to determine the best course of treatment for each patient.
How effective is TACE?
The effectiveness of TACE varies depending on several factors, including the size and number of tumors, the patient's overall health, and liver function. Generally, TACE has been shown to improve survival rates and quality of life in patients with intermediate-stage HCC. It is not considered a curative treatment but can significantly shrink tumors and control disease progression.
Conclusion
Transarterial chemoembolization (TACE) is a valuable tool in the management of liver cancer, offering targeted therapy with fewer systemic side effects. While it is associated with some risks, its benefits in terms of tumor control and symptom relief make it a widely used and effective treatment option for patients with intermediate-stage HCC and other liver malignancies.
