Transarterial chemoembolization

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.

TACE complications

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.

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.