Chemoembolization
Chemoembolization, also known as transcatheter chemoembolization (TACE), is a minimally invasive cancer treatment primarily targeting tumors in the liver. This procedure involves delivering chemotherapy drugs directly into a tumor via a catheter placed in the artery that supplies blood to the cancer. By blocking the tumor's blood supply, chemoembolization helps to shrink the tumor while minimizing damage to surrounding healthy tissue. It is particularly effective for primary liver cancers and for metastatic cancers that have spread to the liver, though it may also be applied to other cancer types such as breast and neuroendocrine tumors.
Before the procedure, patients undergo thorough assessments to ensure they are suitable candidates, as those with certain liver conditions or other health issues may be ineligible. The treatment is generally performed by an interventional radiologist and may require a short hospital stay for monitoring post-procedure. While chemoembolization can offer significant benefits, such as higher localized doses of chemotherapy and fewer systemic side effects compared to traditional chemotherapy, it is not considered a curative treatment. Instead, it is often used for palliative care to manage symptoms and improve quality of life. Regular follow-up imaging is typically conducted to monitor treatment effectiveness.
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Chemoembolization
ALSO KNOWN AS: Transcatheter chemoembolization, transarterial chemoembolization (TACE)
DEFINITION: Chemoembolization is a method of treating cancer by introducing chemotherapy drugs directly into a tumor using a catheter placed in an artery that supplies blood flow to the cancer. Chemoembolization works by blocking healthy blood flow to the tumor, thereby shrinking the tumor. It is among the minimally invasive procedures category because it targets the cancer and spares healthy tissues.
Cancers treated: Primary liver cancer (hepatoma)ther cancers, such as colon cancer, that have metastasized to the liver. Individuals who have an obstruction in vessels of the liver or have liver diseases such as cirrhosis are not usually eligible for chemoembolization. Others who are ineligible are those experiencing bile duct blockage, kidney disease, blood clotting disorders, and metastatic cancers that have spread to multiple organs.
The use of chemoembolization also depends on the number and size of the tumors. Other types of cancers chemoembolization can be employed against include:
- breast,
- neuroendocrine,
- ocular melanoma, and
- sarcoma.
Why performed: Chemoembolization is used primarily for cancer in the liver, whether the cancer is confined to the liver or has spread to the liver from another organ. It is sometimes used in combination with surgery, external radiation therapy, or other cancer treatments. In advanced cancers, chemoembolization is used as a palliative treatment (directed at providing comfort and quality-of-life care) to manage symptoms related to cancer, such as pain or fluid buildup in organs.
Chemoembolization offers advantages over traditional chemotherapy, since high doses of chemotherapy drugs can be given directly into the tumor rather than systemically. Also, since the blood supply to the tumorneeded for tumor growthis blocked, the chemotherapy drugs can remain in direct contact with the cancer for a longer time than with traditional chemotherapy. The treatment can also be given more often, usually with fewer side effects, since the drug is limited to distribution directly to the tumor area and is not circulating throughout the body. Chemoembolization is also more cost-effective than some other cancer treatments, such as surgery or conventional radiation therapy.
Patient preparation: A few days prior to the procedure, the patient has blood work to ensure good liver and kidney functioning. Blood-clotting tests are also done to ensure the patient’s blood clots properly.
The patient is usually seen by an interventional radiologist, a medical doctor who is specially trained in treatment and diagnostic procedures using catheters, probes, and image X-ray guidance. The interventional radiologist will perform the chemoembolization procedure. The physician will also need to know if the patient is taking any blood-thinning medications, such as aspirin or coumadin, since they can affect the procedure. The patient is usually admitted to the hospital on the day of the procedure.
Steps of the procedure: An intravenous (IV) line is started in the patient to administer medication and provide fluid throughout the procedure. Although medication is given through the IV to help the patient relax, the patient is essentially awake throughout the procedure.
An interventional radiologist performs the procedure under angiographya special X-ray of the arteries and veinsso that the catheter can be placed in the correct vessel that supplies blood to the tumor. A local anesthetic is used to numb the femoral artery area in the groin, where a small incision is made through which the catheter will be inserted. The physician follows the catheter placement via a monitoring screen.
Once the interventional radiologist has threaded the catheter through the artery branches supplying the tumor, the chemotherapy drug used to embolize or block the blood supply is injected through the catheter. The patient may feel a momentary pressure or burning sensation.
After the procedure: After the chemoembolization, a pressure dressing is applied to the groin, and the patient must lie flat for approximately eight hours. Patients may experience pain in the tumor area or groin and possibly some nausea and fever as a result of the procedure. Since these symptoms may last for up to a week, patients are given pain medications to control symptoms and antibiotics on discharge from the hospital. Usually, a one- to two-night stay in the hospital is required so that the patient can be monitored. Most patients can resume normal activities within one to two weeks.
The interventional radiologist usually orders a follow-up computed tomography (CT) scan or magnetic resonance imaging (MRI) one month after chemoembolization to assess the continued effectiveness of the treatment on the tumor. After that, a CT scan or MRI is usually done every three months.
Risks: As with any invasive procedure, there are potential risks. Risks of the chemoembolization procedure include infection at the catheter insertion site or blood clots in vessels other than the one supplying the tumor.
Results: Chemoembolization is considered a treatment for liver cancer but should not be considered curative. Although it may be used to treat liver tumors and cause shrinkage and symptom control, studies to date have not suggested chemoembolization as a cure or first-line treatment.
Bibliography
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