Transarterial chemoembolization (TACE) is a nonsurgical way to treat certain tumors in the liver.
TACE may be performed on patients who have tumors that developed from the liver itself (hepatocellular carcinoma) or sometimes for patients with tumors of other parts of the body, such as from colon cancer, that have spread to the liver, if there are not too many sites of spread (metastases).
TACE delivers medications directly to the tumor in the liver using a catheter (a small flexible tube) that is inserted into an artery in the groin area. The TACE procedure is performed by a specialist, typically an interventional radiologist, who makes a very small incision in the groin to insert the catheter into the femoral artery. The catheter is then directed up through the aorta and to the hepatic artery, which provides the main blood supply to a tumor in the liver.
TACE can be used to deliver both chemotherapy and a substance that leads to blot clotting, or embolization. Embolization results in the blood supply to the tumor being blocked, which causes the cancer cells to die from lack of oxygen and nutrients. The substance used can be either tiny “microspheres,” metal coils, or a specialized gel.
Chemotherapy is delivered directly to the cancer at concentrations higher than can be achieved by giving it through a vein. The loss of blood flow from embolization keeps chemotherapy from being washed away from around the cancer, making it more effective.
Following TACE, treated tumors will often shrink significantly or even die, with no further living cancer cells remaining.
There is a small risk of bleeding and/or damage to blood vessels as well as infection. Intravenous contrast is also used to direct the catheter, which may have risks in people with kidney disease. This is associated with a small risk of an allergic reaction, kidney damage, or hypothyroidism (reduced function of the thyroid gland).
Because TACE commonly causes significant death to cancer cells immediately after the procedure, it can lead to a lot of inflammation in the area. Patients who undergo TACE commonly (about 60%-80% of the time) experience a postembolization syndrome of abdominal pain, fever, and low energy hours to days after the procedure. They can also have some liver function blood test results become abnormal. This syndrome typically resolves with time on its own, with pain medication, and sometimes intravenous fluids if needed. Antibiotics are not routinely needed.
Arterial chemotherapy infusion of the liver, chemoembolization of the liver (TACE)http://www.medicinenet.com/chemo_infusion_and_chemoembolization_of_liver/article.htm
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Published Online: October 15, 2015. doi:10.1001/jamaoncol.2015.3702.
Conflict of Interest Disclosures: None reported.
Howard (Jack) West, Jill O. Jin. Transarterial Chemoembolization. JAMA Oncol. 2015;1(8):1178. doi:10.1001/jamaoncol.2015.3702