Trans-arterial chemo-embolisation (TACE)
TACE is a method used to treat very vascularised liver tumours.
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How does TACE work?
Primary liver cell cancer (hepatocellular carcinoma, HCC) has the unusual property of being very well supplied by the hepatic artery (just like other types of liver tumour and liver metastases for which trans-arterial chemo-embolisation is also possible). Healthy tissue, on the other hand, is supplied via the portal vein.
The phenomenon of this different blood supply is used in TACE to bring the chemotherapy agent directly to the tumours.
TACE also has an indirect effect: the closure of the supplying arteries (embolisation) cuts off the tumour’s supply of oxygen and nutrients (Figure 2a and b in the case example).
What are the goals of TACE?
The aim of TACE is to prevent the disease (e.g. tumour growth) from progressing for a long as possible and to reduce the patient’s symptoms. There are also other palliative therapy options available for this (see also elsewhere on this website) – TACE, however, is always the procedure of choice when tumours are more than 3 cm in size, when patients have fluid on the abdomen (ascites) or when they are on the list for liver transplantation. Often it is months before a new organ becomes available. TACE can prevent tumours growing during this time, by which the patient may no longer be suitable for liver transplantation (bridge to transplantation).
TACE is also often used in patients whose tumour is too large for conventional surgery or resection. In this case, the aim is to shrink the tumour so that resection or surgery can be carried out later (= downsizing).
How is TACE carried out?
Beforehand
A precise determination of the indication and careful preparation are needed for TACE.
In preparation for the procedure, we evaluate the case history and any diagnostic results already available, such as CT images, MRI scans and, if available, PET-CT scans (positron emission computed tomography). To this end, we request that a detailed medical history is provided, with a list of the treatments already applied, an indication of the progression of the disease, and the most up-to-date diagnostic images available.
Based on the documents supplied, we can check whether the most important requirements for TACE are fulfilled. If this is the case, the patient will be invited for a further consultation and work-up at our outpatient clinic for minimally invasive tumour therapy. You can arrange an appointment for this by calling +49 (0)30 / 450 557 309.
During
Patients are admitted to our unit for around three to four days for TACE.
During the procedure, a very fine catheter (microcatheter) is guided via the artery in the groin up to just before the tumour (Figure 1). The chemotherapy agent is then administered directly into the tumour via this catheter. The arteries supplying the tumour are then sealed with fine particles (embolisation) so that the chemotherapy agent remains in the tumour for as long as possible. (At the Charité, our chemotherapy agent of choice is a mixture of Lipiodol, Doxorubicin and Mitomycin C).
After
Since TACE is generally delivered via one of the arteries in the groin, a pressure dressing is applied and patients must remain in bed for several hours. The following day, we generally carry out a CT scan of the abdomen to document the deposition of the medication in the tumour.
The embolisation process is usually repeated six to eight weeks later, since liver cancer has a propensity to form new blood vessels. These too must then be sealed off.
Later on, the outcome of the treatment is once again checked via a CT scan or MRI scan to determine whether a third TACE procedure is needed – or whether further treatment steps need to be planned.
After the treatment, patients can go about their normal everyday lives without any restrictions.
What complications should patients be aware of?
Serious complications from TACE are very rare.
Of course, even with TACE, we must also be aware of the general risks, such as allergies to the medications used. We reduce these risks as much as possible by taking a thorough history in advance and possibly by administering special doses of the medication.
Bleeding at the puncture site can also occur, as is the case with any procedure involving an artery (angiography).
One typical side effect of TACE is "post-embolisation syndrome". This is the name given to a complex of symptoms that often manifests itself in the form of nausea, pressure in the upper abdomen, pain, joint pain and sweating. This is a normal reaction by the body. It is caused by dying tissue releasing messenger substances. Generally speaking, the severity of these symptoms correlates with the size of the tumour and the response to therapy. Symptoms are generally controlled effectively during the inpatient stay, however.
Case example
Figure 2: The figure shows the treatment of a hepatocellular carcinoma (HCC) using trans-arterial chemo-embolisation (TACE).
1. Large, well vascularised carcinoma before embolisation; the microcatheter has already been advanced into the supplying artery within the liver.
2. The embolisate can be seen in the tumour and the interruption of the tumour’s vascular supply.
Bibliography
- S3-Leitlinie Hepatozellulläres Karzinom. www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/HCC/S3-HCC-OL-Langversion-V1.0.pdf [external PDF, 2,8 MB]
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