What is Transarterial Chemoembolization (TACE)?

From the Guidelines

TACE (Transarterial Chemoembolization) is a minimally invasive procedure used primarily to treat liver cancer, especially hepatocellular carcinoma, by delivering chemotherapy drugs directly to the tumor while blocking its blood supply, as recommended by the most recent expert consensus-based practical recommendations of the Korean Liver Cancer Association 1.

Definition and Procedure

TACE involves the combination of selective injection through the hepatic artery of antineoplastic agents and selective obstruction of tumoral feeding vessels. The procedure is typically performed under conscious sedation, takes 1-2 hours, and may require 1-2 days of hospitalization.

• Chemotherapy drugs (commonly doxorubicin, cisplatin, or mitomycin C) mixed with an embolic agent are injected, which both delivers high concentrations of chemotherapy to the tumor and blocks blood flow to it, causing tumor cell death.
• TACE can be classified as conventional TACE (cTACE) using chemoemulsion, a mixture of Lipiodol and chemotherapeutic agents, and drug-eluting bead TACE (DEB-TACE) using microspheres loaded with chemotherapeutic agents 1.

Indications and Recommendations

TACE is typically recommended for patients with intermediate-stage liver cancer who aren't candidates for surgery or ablation, those with multiple tumors, or as a bridge to liver transplantation, as supported by multidisciplinary consensus recommendations for management of hepatocellular carcinoma in the Middle East and North Africa region 2.

• The procedure is usually performed under conscious sedation and may require 1-2 days of hospitalization.
• Patients typically undergo multiple TACE sessions spaced 4-8 weeks apart.

Side Effects and Prognosis

Side effects include post-embolization syndrome (fever, pain, nausea), which usually resolves within a week.

• The prognosis of HCC patients undergoing TACE is highly variable, and various prognostic scores have been developed to standardize assessment across institutions, such as the assessment of retreatment with TACE score and the hepatoma arterial embolization prognostic score (HAP score) 2.

Recent Guidelines and Recommendations

The Korean Liver Cancer Association and Korean Society of Interventional Radiology jointly composed a panel of experts to draw consensus-based practical recommendations for TACE, which were announced at the 17th Annual Conference of KLCA in March 2023 and have been endorsed by the KSIR 1.

• These recommendations prioritize patient selection, pre-treatment management, preparation of chemoembolic materials, procedural techniques, procedure intervals, and post-treatment assessment to enhance procedural efficacy, safety, and ultimately patients’ survival and quality of life.

From the Research

Definition and Overview of TACE

• Transarterial chemoembolization (TACE) is a standard treatment for intermediate-stage hepatocellular carcinoma (HCC) 3, 4, 5, 6, 7.
• TACE involves the transcatheter delivery of chemotherapy using Lipiodol-based emulsion plus an embolizing agent to achieve strong cytotoxic and ischemic effects 3.
• There are two main TACE techniques: conventional TACE (cTACE) and TACE with drug-eluting beads (DEB-TACE) 3, 4, 5, 7.

Indications for TACE

• TACE is recommended as first-line non-curative therapy for BCLC B/intermediate HCC (preserved liver function, multifocal, no cancer-related symptoms) in patients without vascular involvement 3, 4, 7.
• TACE can be used for early stage HCC if other curative treatments are not feasible or as a neoadjuvant treatment before liver transplantation 4, 6.
• TACE can also be considered for selected patients with limited portal vein thrombosis and preserved liver function 4.

Techniques and Efficacy of TACE

• Different types of TACE are available, including TAE, c-TACE, DEB-TACE, and DSM-TACE 7.
• The anti-tumor effect of cTACE and DEB-TACE has been reported to be similar, but DEB-TACE carries a higher risk of hepatic artery and biliary injuries and a relatively lower risk of post-procedural pain than cTACE 4.
• TACE has been shown to provide consistent and reliable results and to significantly diminish systemic drug exposure, liver toxicity, and drug-related adverse events as compared with conventional TACE 5.
• The palliative effect in unresectable HCC using TACE allows local tumor control in 15 to 60% of cases and 5-year survival rates ranging from 8-43% 6.