TACE

Transarterial Chemoembolization (TACE) is a liver-directed interventional radiology procedure that combines targeted delivery of chemotherapy with embolization to block arterial blood flow to hepatic tumors. Since liver tumors often rely on the hepatic artery, TACE aims to maximize local chemotherapy exposure and tumor ischemia while limiting systemic toxicity. It is most commonly used for hepatocellular carcinoma (HCC).

There are two main variants: conventional TACE (cTACE), which uses an emulsion of a chemotherapeutic drug with lipiodol followed by embolic particles; and drug-eluting bead TACE (DEB-TACE), in which beads deliver chemotherapy slowly over time.

Indications include unresectable HCC in patients with adequate liver function and performance status. TACE may also be used for selected liver metastases (for example from neuroendocrine or colorectal primaries) as palliation or as a downstaging step before other treatments.

Procedure: Access via femoral or radial artery; selective catheterization of hepatic branches; administration of the chemotherapy–lipiodol emulsion or drug-eluting beads; embolization with particles; imaging confirms targeting; patients are monitored; hospital stays are typically short.

Outcomes: TACE can achieve local tumor control and may improve survival in appropriately chosen patients. It is not curative; many patients require repeated sessions and careful monitoring for liver function and tumor response.

Risks and complications: Post-embolization syndrome—fever, pain, and nausea—is common but usually self-limited. Serious events include liver failure in decompensated patients, biliary injury, liver abscess, non-target embolization, and, rarely, death.

Alternatives include Y-90 radioembolization (TARE), ablation, resection, transplantation, or systemic therapy (e.g., sorafenib or lenvatinib), depending on tumor burden and liver reserve.