Transarterial Chemoembolisation (TACE)

Authors: Dr Gerald Goh*
                            Dr Timothy Joseph *

What is a transarterial chemoembolisation of the liver?

Transarterial chemoembolisation (TACE) is a targeted treatment that treats cancers (tumours) in the liver and other cancers that have spread to the liver (metastases). Other options to completely treat these cancers include surgery to remove the tumours, ablation of the cancer (directly damaging it with heat, freezing or electrifying, via a needle through the skin) or liver transplantation. TACE may be carried out to improve patient survival using chemotherapy.

The term “chemoembolisation” combines the effect of delivering cancer drugs (chemotherapy) directly into the tumour and starving the tumour of its blood supply (embolisation).

Why would my doctor refer me to have this procedure?

If you have cancer in the liver your doctor will assess:

• if the cancer(s) can be safely surgically removed;
• whether liver transplantation is an option;
• if ablation (directly damaging the tumour(s) with heat, freezing or electrifying, via a needle through the skin) is best for you; or
• if they think that TACE is the best option.

If your doctor thinks that the tumours are more appropriate for TACE, your blood tests and medical history will be reviewed by a specialist interventional radiologist (specialist doctor) (see InsideRadiology: Interventional Radiology) to assess if TACE is suitable for you.

How do I prepare for a transarterial chemoembolisation?

Before TACE you will need to fast (no food or drink) for several hours. The hospital/practice where you are having TACE will give you information about this . A number of medications are given before the procedure to minimise the risk of infection, nausea and pain. Sedation and analgesia (pain relief) are often given. Some patients may require the insertion of a catheter (a thin tube) into the bladder if the procedure is expected to be of long duration

What happens during a transarterial chemoembolisation?

The chemotherapy drugs are sent to the liver cancer directly via the arteries. A needle and a short tube (sheath) are inserted into an artery in the groin. A thin longer tube (catheter) and wires are then passed up into the artery supplying blood to the liver through the sheath. X-ray images or pictures are taken by a special X-ray machine after injecting X-ray contrast sometimes referred to as ‘dye’. A smaller catheter is then placed as close to the cancer(s) as possible. Chemotherapy, combined with another specialised X-ray contrast, is slowly injected directly into the cancer(s). This is sometimes followed by the injection of small plastic particles that slow or block blood flow to the tumour, increasing the duration of action of the chemotherapy and further starving the tumour of its blood supply. An alternative TACE method involves the insertion of tiny beads impregnated with chemotherapy through the catheter directly into the tumour. Some patients may require multiple treatments due to the number of liver tumours or if the tumours are large.

Before the catheter and sheath are removed from the groin, X-ray images, or pictures, are taken to assess if the tumours have been adequately treated. Most patients will remain in hospital for a short time to be observed and have some blood tests after the procedure.

Are there any after effects of a transarterial chemoembolisation?

After effects following transarterial chemoembolisation of the liver are generally limited. Patients may feel lethargic or suffer from mild upper abdominal discomfort for a few days. A low-grade fever and nausea are not uncommon. These are generally related to treatment of the tumours and injury to the abnormal cells by the chemoembolization, and symptoms can be similar to that after having other forms of chemotherapy.

How long does a transarterial chemoembolisation take?

TACE procedures are generally scheduled as a half-day procedure taking 2–4 hours, although they may not always take that long. Some patients may be asked to return for further treatment (3–4 weeks later), depending on the size, number and location of the tumours.

What are the risks of a transarterial chemoembolisation?

Major complications following TACE are relatively rare, at approximately 4%. These can include worsening of your liver function, liver infection or bleeding from the liver or the tumour. These would likely be picked up by your doctors before leaving hospital. Bleeding or bruising in the groin can also occur. A small number of patients may develop gall bladder infections or other complications from starved blood supply to areas other than the liver. Less than 1% of people have complications including cardiac (heart) issues, kidney impairment or altered blood levels. Life-threatening complications are exceedingly rare (<1%).

What are the benefits of a transarterial chemoembolisation?

Evidence has shown a reduction in cancer tumour size, decreasing abnormal levels of cancer blood tests, and improved quality of life and symptoms. Current evidence suggests that TACE can provide a significant improved 2-year survival after the procedure is carried out.

Who does the transarterial chemoembolisation procedure?

TACE is carried out by trained interventional radiologists (specialist doctors) with the assistance of radiology nursing staff and radiographers who assist in taking the X-ray images.

Where is a transarterial chemoembolisation done?

TACE is carried out in a dedicated special X-ray angiography (See InsideRadiology: Angiography) imaging suite, generally in a hospital.

When can I expect the results of my transarterial chemoembolisation?

The results of your TACE will be given to your referring doctor in the form of a report. Reports should generally be available the following day, although this will vary at different hospitals/practices.

Whether the liver tumours have responded to the TACE will depend on follow-up imaging (usually computed tomography scans), which is usually carried out 3–16 weeks after the procedure. At this time, assessment to see if the tumours have shrunk will be made. Your referring doctor usually arranges this CT scan for you after your TACE procedure.

It is important to ensure you have a follow-up appointment with your referring doctor at some stage after the TACE procedure.

Further information on transarterial chemoembolisation

A few weeks after TACE has been carried out, you will generally have follow-up blood tests to monitor the blood cell levels, kidney and liver function tests, and cancer marker blood levels.
A computed tomography scan is generally carried out in a few weeks to months after TACE to assess the cancer’s response to the treatment.

References

Llovet,JM. Burroughs, A. Bruix, J. Hepatocellular Carcinoma. Lancet 362:1907-1917, 2003
Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology. 2003 Feb;37(2):429-42

*The authors has no conflict of interest with this topic.

Page last modified on 16/6/2022.