Transarterial chemoembolization (TACE)

What is meant by transarterial chemoembolization (TACE)?

TACE is a procedure that involves blocking (embolizing) the arterial blood supply to a tumor and injecting chemotherapeutic drugs directly into the artery that feeds the tumor. A catheter is placed in the femoral artery and used to select the hepatic artery. The catheter in the hepatic artery is used for delivery of the embolic agent and drugs. The catheter is removed immediately after treatment.

What is a typical mixture used to perform Transarterial chemoembolization?

There is no standard mixture of chemotherapy drugs or embolic agents that is widely used for TACE.

What is the purpose of ethiodized oil (Ethiodol) in the Transarterial chemoembolization mixture?

Ethiodol is used during TACE because it is selectively retained by tumor cells, is radiopaque, and can be seen under fluoroscopy during chemoembolization as well as on CT.

What types of patients should be considered candidates for Transarterial chemoembolization?

TACE is a liver-directed therapy for liver tumors. It works best in HCC when the tumor has not spread to extrahepatic sites. The best therapy for HCC is often liver transplantation. TACE is used to control HCC while the patient is on the transplant list awaiting liver transplantation. For patients who are not transplant candidates, TACE offers a noncurative treatment for HCC. For metastatic lesions to the liver, TACE is best used when disease outside the liver is well controlled, and the metastatic lesions to the liver represent the biggest threat to the patient’s health.

How are patients followed after TACE, and when is retreatment indicated?

Patients are generally admitted for 1 night in the hospital after TACE. Patients receive a post-TACE CT or magnetic resonance imaging (MRI) examination and are seen in an outpatient interventional radiology clinic 1 month after TACE. Additional clinic visits and imaging with MRI or CT of the liver are done every 3 months to evaluate the success or failure of the procedure. Retreatment can be performed and is usually indicated if follow-up imaging shows new masses in the liver or recurrent disease at the site of the treated tumor.

What is the typical imaging and clinical workup prior to TACE?

Before TACE, patients are seen in the interventional radiology clinic, and a full history and physical examination are performed. MRI or CT is obtained within 1 month of the planned TACE. Within 1 week of the procedure, blood work is performed that includes complete blood count, international normalized ratio (INR), serum creatinine, and liver function tests.

What medications are patients typically treated with after TACE?

After TACE, patients are given powerful antibiotics to lessen the chance of infection and intravenous medications to control nausea and pain while they are in the hospital. When they are sent home, patients receive a 5-day course of an oral antibiotic and oral medications for nausea and pain.

What is the major risk factor for hepatic abscess formation secondary to TACE?

Hepatic abscess is always mentioned as a risk after TACE, but the risk increases greatly if the patient does not have a competent sphincter of Oddi. This can occur because of biliary stent placement or because of a biliary bypass procedure. Bacteria from the intestines can then colonize the biliary tree, leading to an increased risk of hepatic abscess formation after TACE.

What laboratory values are checked when determining candidacy for TACE?

Within 1 week of the procedure, blood work is performed, which includes complete blood count, INR, serum creatinine, and liver function tests. If the patient has an elevated INR, bilirubin, aspartate aminotransferase (AST), or alanine aminotransferase (ALT), this may indicate that the patient has some degree of liver failure. Preexisting liver failure increases the risk of TACE and may be a reason not to perform the procedure.

What does one look for on follow-up imaging to evaluate the success of a TACE procedure?

After TACE, MRI or CT of the abdomen is performed with intravenous contrast material. The intravenous contrast material causes the tumors to enhance if they are still viable. If a tumor is successfully treated, it is necrotic and will not enhance after contrast material administration. In patients who had elevated tumor markers prior to treatment, a subsequent decrease in tumor marker levels after treatment would also be an indication of successful TACE.


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