Transarterial chemoembolization introduces cancer-fighting drugs and an embolic agent into the artery feeding the tumour. It has a double harmful effect on the malignant neoplasm: killing cancerous cells with chemo drugs and cessation of its blood supply. However, the method is minimally invasive, does not cause side effects and complications, and has a high success rate.
Transarterial chemoembolization (TACE) combines the therapeutic effects of embolization and regional chemotherapy. It is an endovascular technique of clogging the arteries feeding the tumour with a material containing a cancer-fighting drug.
In addition, combining chemotherapy and ischemia allows simultaneous effects to achieve maximum tumour destruction. Using TACE, a high dose of the chemotherapeutic agent is targeted, whereby the contact time between the drug and the tumour cells is extended. Depending on the used embolizing material, it is divided into two methods:
- Conventional (c-TACE)
The specialist mixes chemical preparation with an oily contrast agent (lipiodol) to make a suspension. Oil particles get stuck in the dilated arteries of the tumour, stopping the blood flow through them. And then, the chemotherapy drug is released and affects the cancerous cells.
- Drug-Eluting Beads (DEB-TACE)
The doctor mixes chemo drugs with unique microspheres, and within 30-60 minutes, the spheres absorb the drug (are loaded). Then, packed spheres are injected into the target artery through a microcatheter and carried inside the tumour centre by the blood flow.
TACE step-by-step description
Local chemotherapy is carried out under local anaesthesia. First, a doctor punctures a femoral, brachial, or radial artery. The insertion site is chosen individually, taking into account the vascular anatomy and discussing it with the patient in advance.
In the case of liver cancer, a catheter is inserted into the common hepatic artery, through which angiography is performed (a contrast study of the liver arteries). After studying the angiography results, the target vessels are determined (sometimes there are several).
An interventional radiologist slowly introduces a pre-prepared mixture of cytostatic-lipiodol (c-TACE) or cytostatic-loaded microspheres (DEB-TACE) into the opening of the microcatheter. The doctor checks the vessels and the drug in real-time during the procedure.
After the end of the procedure, a physician removes the microcatheter, makes a control angiography and takes out the catheter. Finally, a doctor put a pressure bandage on the puncture site for up to 12 hours.
When local chemotherapy can be an option?
Chemoembolization is noted in the European protocol for treating hepatocellular carcinoma (HCC - middle stage, multinodular form). Multistage embolization must be more effective than a single one. Therefore, specialists use it for monotherapy combined with other methods.
In addition, there are successful results of using TACE for treating cholangiocarcinoma, colorectal, breast and neuroendocrine metastases in the liver. Researchers are describing the treatment of metastases of sarcoma and pancreatic cancer by chemoembolization. Numerous doctors are practising local chemotherapy for many cancers in different locations. Usually, it shows better results compared with traditional options.
Advantages of transarterial chemotherapy
Numerous studies have proven that chemoembolization significantly increases the duration and quality of life in patients with inoperable liver tumours. Using TACE in combination with other minimally invasive techniques has an even more remarkable effect on most patients. It can transfer an inoperable liver tumour from the category of "deadly" to the list of diseases that can recur and require constant monitoring and treatment.
Patients and doctors note the main three advantages of the method:
- Minimal impact on healthy cells while preserving the integrity of liver tissue and its functions;
- High success rates and patient survival rates after the procedure;
- A minimally invasive intervention significantly shortens the postoperative period and prevents unwanted complications.
Compared to conventional chemotherapy, a much higher dose of anticancer drugs can be used with local application. And the effect is not systemic. Instead, it regionally targets the malignant neoplasm.
The technique is minimally invasive and not traumatic. That is why it is much safer than traditional surgical intervention. Also, TACE does not cause serious side effects like conventional chemotherapy. Nevertheless, like any intervention, it has certain risks:
- Violation of kidney function;
- Risk of blood clots (especially in children);
- Allergic reaction to contrast agents (they are administered for angiography);
- Liver failure (in case of accidental damage to healthy tissues);
- The possibility of developing an infection.
Multiple studies have shown that the complication rate during local chemotherapy is very low.
Recovery after transarterial chemoembolization
After the intervention, patients can feel dull pain, heaviness in the liver, nausea, and fever. It usually goes away within a few hours to several days. In some cases, the doctor prescribes anti-inflammatory, antiallergic and anti-nausea drugs.
A month later, repeat CT angiography is indicated to determine the indications for repeated TACE. 2-3 times, the use of this technique with an interval of 1-3 months is considered the most effective. In some cases (for those waiting for a liver transplant), it can be performed five or more times.
Is TACE the same as chemotherapy?
TACE is one of the modern forms of local chemotherapy because the basis of the method is also the use of antitumor chemo drugs. But there are two main differences:
- Anticancer substances are injected directly into the artery that supplies blood to the tumour. At the same time, without systemically affecting the entire body.
- The amount of drugs administered is much higher than with conventional chemotherapy. Together with the simultaneous ischemia of the vessel, this kills cancer cells more effectively.
Why do patients come abroad for chemoembolization?
It is primarily because the method is relatively new and not always available in some countries. Clinics abroad are equipped with modern technologies and have access to the necessary certified medications. The experience of doctors plays an equally important role in this field.
What diseases can be treated with TACE?
TACE is the definitive treatment method for patients with hepatocellular carcinoma (HCC). They also must have well-preserved liver function without portal vein tumour thrombosis or extrahepatic metastases. But each case is individual, and a council of doctors choose the most optimal option for each patient. In addition, many cancers can be considered for chemoembolization after reviewing the case.
How long does chemo embolization take?
Everything depends on the anatomy of the tumour's blood supply. It can be 20-30 minutes, sometimes up to 1 hour. The sooner we enter the artery that feeds the malignant neoplasm, the sooner doctors will perform the manipulation itself.
How successful is the chemoembolization method?
After the course, the tumour gradually decreases by 50-95%, depending on its type, blood supply features and embolization quality. In the case of liver damage, it shows promising results. As a result, about 63% of all procedures end favourably. Experts note a reduction in lesions and a reduction in the negative impact on the body. The closer the emboli are to the cancerous tissues, the better the results and the lower the risk of complications.
Where can I get Transarterial chemoembolization?
Germany, Turkey, Israel, India, South Korea are among the best for Transarterial chemoembolization.
What are the best clinics for Transarterial chemoembolization?
Who are the best doctors for Transarterial chemoembolization?
Prof. Dr. med. Thomas J. Vogl from University Hospital Frankfurt am Main of Goethe-University
Dr. med. Anett Tillmann, MBA from Academic Hospital Bundeswehr Berlin
Prof. Dr. med. Philipp M. Paprottka from University Hospital Rechts der Isar Munich
Dr. med. Annette Forschler from Park Clinic Weissensee Berlin
Prof. Dr. med. Jens Ricke from University Hospital Ludwig-Maximilians Munich
What is the price of targeted local chemotherapy?
The average price range for transarterial chemoembolization is 9,000 $ - 34,500 $. The cost depends on the number of sessions, type of drug, the need for diagnostic examinations, and medicine to eliminate postoperative symptoms. The country, the clinic and chosen specialist play an equally important role.
The chemo drug itself is a primary expense in the total bill. However, there are other components included in the process:
- Angiography with contrast;
- TACE therapy itself;
- Follow-up examinations;
- Drugs for symptomatic medicine after the procedure;
- Hospitalisation and recommendations for further treatment.