Transcatheter arterial chemoembolisation
Updates to Article Attributes
Transarterial chemoembolisation therapy (TACE) is a localised method of administrating chemotherapy directly to the liver tumor via a catheter study.
Transarterial embolisation (TAE) (i.e. without a chemotherapy agent added) is also used and there is evidence that this may be just as effective as TACE 1.
Indications
TACE is most commonly used in the treatment of hepatocellular carcinoma (HCC) and selective metastatic disease (most commonly from colorectal carcinoma). It may also be used in cholangiocarcinoma 2.
It can be used as palliative treatment for patient with unresectable HCC or as a bridge to a liver transplant. It may sometimes also be performed prior to radiofrequency tumour ablation.
Contraindications
Absolute contraindications:
- extensive tumour infiltration throughout the liver
- encephalopathy
- large burden of extra-hepatic metastases
Relative contraindications:
- portal vein thrombosis
- liver or renal failure
- uncorrectable coagulopathy
- significant arteriovenous shunting of blood through tumour
Procedure
Chemoembolic particles are used to occlude hepatic arterial supply to the tumour with resultant necrosis. There is wide variability in the type of embolisation particles and chemotherapy, as well as timing 1.
Outcomes
TACE has been shown to have a survival benefit over current treatments as well as reducing patient symptoms and preventing tumour growth 1,2.
CT is typically used for follow up imaging, with the oily based embolic particles having a distinct high attenuation appearance.
One key advantage is the chemotherapy is targeted locally so reducing the systemic side effects of intravenous chemotherapy.
Response to treatment
Imaging is generally advised after 3-4 weeks, either triple phase CT, dynamic MRI or contrast enhanced USG. The accumulation pattern of the iodizediodised oil and enhancement pattern of the mass is to be observed to evaluate the response to the treatment. The more the accumulation greater the necrosis and the survival. Enhancing areas of tumor are considered as residual viable tumor 5.
There are four types of patterns have been described:
-
type 1
- homogeneous accumulation of
iodizediodised oil in the whole tumour and the surrounding area. This type of accumulation indicates good response to treatment
- homogeneous accumulation of
-
type 2
- homogeneous accumulation of
iodizediodised oil in the tumour only
- homogeneous accumulation of
-
type 3
- irregular accumulation with filling defects. This accumulation represents less than optimal
-
type 4
- no accumulation/retention of
iodizediodised oil.
- no accumulation/retention of
-<li><a title="Portal vein thrombosis" href="/articles/portal-vein-thrombosis">portal vein thrombosis</a></li>- +<li><a href="/articles/portal-vein-thrombosis">portal vein thrombosis</a></li>
-</ul><h4>Procedure</h4><p>Chemoembolic particles are used to occlude hepatic arterial supply to the tumour with resultant necrosis. There is wide variability in the type of embolisation particles and chemotherapy, as well as timing <sup>1</sup>.</p><h4>Outcomes</h4><p>TACE has been shown to have a survival benefit over current treatments as well as reducing patient symptoms and preventing tumour growth <sup>1,2</sup>.</p><p>CT is typically used for follow up imaging, with the oily based embolic particles having a distinct high attenuation appearance.</p><p>One key advantage is the chemotherapy is targeted locally so reducing the systemic side effects of intravenous chemotherapy.</p><h4>Response to treatment</h4><p>Imaging is generally advised after 3-4 weeks, either triple phase CT, dynamic MRI or contrast enhanced USG. The accumulation pattern of the iodized oil and enhancement pattern of the mass is to be observed to evaluate the response to the treatment. The more the accumulation greater the necrosis and the survival. Enhancing areas of tumor are considered as residual viable tumor<sup> 5</sup>.</p><p>There are four types of patterns have been described:</p><ul>- +</ul><h4>Procedure</h4><p>Chemoembolic particles are used to occlude hepatic arterial supply to the tumour with resultant necrosis. There is wide variability in the type of embolisation particles and chemotherapy, as well as timing <sup>1</sup>.</p><h4>Outcomes</h4><p>TACE has been shown to have a survival benefit over current treatments as well as reducing patient symptoms and preventing tumour growth <sup>1,2</sup>.</p><p>CT is typically used for follow up imaging, with the oily based embolic particles having a distinct high attenuation appearance.</p><p>One key advantage is the chemotherapy is targeted locally so reducing the systemic side effects of intravenous chemotherapy.</p><h4>Response to treatment</h4><p>Imaging is generally advised after 3-4 weeks, either triple phase CT, dynamic MRI or contrast enhanced USG. The accumulation pattern of the iodised oil and enhancement pattern of the mass is to be observed to evaluate the response to the treatment. The more the accumulation greater the necrosis and the survival. Enhancing areas of tumor are considered as residual viable tumor<sup> 5</sup>.</p><p>There are four types of patterns have been described:</p><ul>
-<strong>type 1</strong> <ul><li>homogeneous accumulation of iodized oil in the whole tumour and the surrounding area. This type of accumulation indicates good response to treatment</li></ul>- +<strong>type 1</strong> <ul><li>homogeneous accumulation of iodised oil in the whole tumour and the surrounding area. This type of accumulation indicates good response to treatment</li></ul>
-<strong>type 2 </strong><ul><li>homogeneous accumulation of iodized oil in the tumour only</li></ul>- +<strong>type 2 </strong><ul><li>homogeneous accumulation of iodised oil in the tumour only</li></ul>
-<strong>type 4</strong><ul><li>no accumulation/retention of iodized oil.</li></ul>- +<strong>type 4</strong><ul><li>no accumulation/retention of iodised oil.</li></ul>
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