Chemoembolization

Chemoembolization, often referred to as transarterial chemoembolization (TACE), is a minimally invasive procedure used to treat liver tumors by delivering chemotherapy directly into the arteries feeding the tumor and then obstructing blood flow to induce ischemia. The approach concentrates anti-tumor drug exposure while reducing systemic toxicity.

Two main variants exist: conventional TACE (cTACE), which uses chemotherapy mixed with an iodized oil contrast agent (lipiodol) followed by embolic particles; and drug-eluting bead TACE (DEB-TACE), in which beads loaded with chemotherapy release the drug over time while also occluding the vessels.

Performed by interventional radiologists via femoral or radial access, the catheter is guided to the hepatic artery branches supplying the tumor. After angiography confirms tumor supply, the chemotherapeutic regimen is delivered, followed by an embolic agent to block flow and trap the drug within the lesion.

TACE is commonly used for unresectable hepatocellular carcinoma and liver-dominant metastases, especially when curative surgery is not possible. It may serve as a bridge to liver transplantation, or as palliative therapy, and is sometimes combined with other treatments such as ablation.

Efficacy varies with tumor size, liver function, and patient selection. Median survival can be improved in carefully chosen patients. Common side effects include post-embolization syndrome (fever, pain, nausea) and potential liver function deterioration; serious but rare risks include liver failure or non-target embolization.

Contraindications include decompensated liver disease, significant portal hypertension, poor performance status, uncorrectable coagulopathy, and allergy to contrast agents.

TACE emerged in the 1980s as a regional therapy for liver cancer and has since become a standard locoregional treatment in guidelines by professional societies.