Indications
Chemoembolization, also known as trans-arterial chemoembolization or TACE, is a minimally invasive outpatient intra-arterial cancer treatment for those with several different types of liver cancer. TACE relies on two very distinct and equally important principals. First, TACE takes advantage of the fact that healthy parts of the liver have a dual blood supply (from the hepatic artery and the portal vein) whereas tumors have a single blood supply (from the hepatic artery). During a chemoembolization procedure, we inject material that blocks the blood vessels that supply the tumor. By embolizing, or blocking, the blood vessels supplying the tumor, the tumor is cut off from its lifeline and dies. The healthy liver, however, is spared and relies on its second source of blood supply from the portal vein to continue receiving blood. Second, the material used to embolize the blood vessels during a TACE procedure is embedded with chemotherapeutic drugs. When injected, this material localizes within the tumor where it slowly battles the tumor by slowly releasing chemotherapy. This allows for maximum tumor targeting while minimizing the systemic side effects that are traditionally associated with chemotherapy.
Chemoembolization has been used successfully to treat several types of liver cancer. TACE is a well-established option for patients with hepatocellular carcinoma who are not candidates for surgery. It can serve as a stand-alone treatment or can be combined with other therapy. In addition, TACE can be used to treat metastatic colorectal cancer, metastatic neuroendocrine tumor, and other tumors including metastatic medullary thyroid cancer and metastatic melanoma.
Procedural Details
The TACE process begins with an outpatient visit with one of our physicians. During this visit, we take part in an depth conversation about your disease state as well as the goals of treatment. As specialists in image-guided minimally invasive cancer therapy, we think it’s imperative to review your imaging while understanding your disease state together so that we are on the same page. We work closely with your oncologist to determine your candidacy for the procedure based on the type and amount of tumor you have, the location of your tumor, the status of your liver, and your overall health.
Soon after your initial consultation, we will perform your TACE procedure at Albany Medical Center. You typically arrive in our observation area in the morning, which is where you will begin and end your day. From here, you are escorted into one of our procedure suites. During a TACE procedure, we will insert a catheter into a blood vessel in the leg (femoral artery) or wrist (radial artery) through a pinhole in the skin. Using x-rays for guidance, we then maneuver the catheter into the blood vessels of the liver. We then take pictures of all the blood vessels supplying the liver allowing us to distinguish which blood vessels supply healthy liver and which blood vessels supply tumor. Once this is determined, we navigate our catheter into the very blood vessel or vessels that supply the tumor. At this point, we begin to embolize the blood vessels. In a classic TACE procedure, we inject a mixture of viscous contrast emulsified with chemotherapy. In a DEB (drug-eluting bead) TACE procedure, we inject tiny beads embedded with chemotherapeutic drugs directly into the tumor. This procedure may be known as DEBDOX if the chemotherapy therapy administered is doxorubicin and DEBIRI if the drug used is irinotecan. The choice of drug depends on the type of tumor being treated. We are able to monitor the deposition of our injected material directly into the tumor live under x-ray guidance. We continue to inject our embolic material until the entire tumor is saturated with the chemotherapeutic drug while the blood supply to the tumor is completely eradicated.
Video courtesy of the Interventional Initiative (http://www.theii.org/)
Results
Following a TACE procedure, a majority of our patients spend a few hours with us for monitoring in our recovery room before going home. A select few, however, require overnight admission in the hospital for pain control. This is because immediately after our procedure, the tumor dying process begins. Not only can this process cause pain, it can sometimes be associated with low-grade fevers and nausea, a constellation of symptoms known as the post-embolization syndrome. This is most intense in the initial 24 hours after the procedure as the tumor is in shock from losing its blood supply. Although a majority of patients are able to tolerate this process with over-the-counter medications at home, some patients, especially those with larger tumors, may require intravenous medications and an over night admission before being able to transition home comfortably.