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Transarterial Chemoembolisation for Liver Cancer

Background:

Transarterial Chemoembolisation is a form of chemotherapy delivered through the arteries that allows treatment to be targeted at the liver tumour and minimises the amount of chemotherapy the rest of the body is subject to. The word “transarterial” indicates that the therapy is delivered through the arteries and the word chemoembolisation means that the tumour is targeted with both chemotherapy and that the blood vessel leading to the tumour is embolised/blocked. This blocking helps to reduce the blood supply to the tumour and also to keep the chemotherapy in its desired location within the tumour.
Liver tumours are uniquely suited to this type of therapy due to the fact that the normal liver has a dual blood supply from both the artery and the portal vein. Normal liver is supplied mostly by the veins and liver tumours are supplied mostly from the artery. Therefore treatments delivered into the artery target the tumour and tend to spare the surrounding liver.
TACE is one of a number of therapies that directed at liver tumours and is normally chosen in patients whose disease is of intermediate severity. In limited disease in certain locations, surgery or ablation (heating) of the tumours may be the correct choice. In more advanced tumours, liver function may not be adequate to cope with TACE therapy. The best choice of therapy is usually chosen by discussion or team meeting between surgeons, oncologists and radiologists, taking into account the patient’s preferences.

The procedure:

TACE therapy is performed in a radiology x-ray suite. On average a treatment takes 2 hrs. Local anaesthetic and twilight anaesthesia is normally administered. You can expect to feel a brief sting from local anaesthesia and then the procedure itself is normally not painful. You will be awake and able to talk and ask questions. You may feel completely normal or slightly sleepy/relaxed due to the twilight medications.
The procedure is performed via a small tube normally via the right groin. A thin plastic tube is guided via xray control through the arteries into the liver artery. A map of the blood vessels including the tumour is then taken using injections of iodine dye (the same dye as used in CT scans) and the treatment planned. Then a smaller tube is directed up to near the liver tumour and the chemotherapy is slowly dripped in to target the tumour. About 1/3 of patients feel a dull ache or nausea during the chemotherapy administration (if that is the case, medications will be given) and the remainder of patient feel very little during the process.
Following treatment, further images of the blood vessels will be taken and the tube removed from the groin. A period of 2-10 minutes of the doctor pressing on the artery will be required after the tube is removed and you will be asked to lay in bed for 4-6 hours after the procedure to minimise the risk of bruising/bleeding from the artery. An overnight stay in hospital is planned for monitoring and any medications that may be needed.

What is the aim of the procedure?

It is important to realise that TACE is not a treatment that can obtain cure from liver cancers, but that it aims to keep the tumour “under control” by slowing growth of the targeted tumours. This means that patients with liver tumours treated with TACE can live significantly longer than those without the treatment .
At the end of the procedure, the doctor will have an idea of how successful the treatment was in terms of depositing the desired dose of chemotherapy into the tumour. The response of the tumour to the chemotherapy is accessed on a follow up CT scan which is normally done 1 month after the treatment. Commonly, patients can return for repeat TACE procedures if other tumours grow in the future or if the response of the treated tumour is incomplete.