Trans-Arterial Chemoembolization (TACE)

Patients who are typically referred for TACE have either primary liver cancer (hepatocellular carcinoma) or metastatic liver cancer and are not eligible for a surgical tumor removal because of the tumor’s size or location. In these cases, TACE may be offered as a minimally invasive approach to help improve patient quality of life and overall survivability. Cancer patients who are candidates for a liver transplant may undergo TACE to extend their lifespan while waiting for a liver to become available.

TACE is a two-hour procedure typically performed in a radiology suite. A sedative will be delivered intravenously to help the patient relax, and numbing medication will be placed on the thigh. Next, an interventional radiologist makes a small incision to place a catheter (thin plastic tube) in the patient’s thigh to reach the femoral artery (a large artery that carries blood to the leg). Using X-ray guidance, the catheter is threaded from the femoral artery through to the hepatic (liver) artery. Once the catheter is at the site, chemotherapy medication (commonly doxorubicin or cisplatin, which kill cancerous cells) and embolization materials (specialized beads and coils that block off the tumor’s blood supply) are simultaneously released.

TACE is primarily considered to be a palliative treatment for liver cancer. In other words, TACE will not cure a patient but may open up other treatment opportunities. For example, if TACE can shrink the tumor significantly and the staging can be improved, surgical tumor resection may become an option for previously inoperable patients. If surgery is still not plausible, TACE still provides the benefit of improved symptoms from a smaller tumor mass.

While the side effects of TACE are typically minimal, a patient’s post-treatment experience will be dictated by the size of the original tumor, liver function, and overall health. Symptoms experienced after the procedure may be related to “post-embolization syndrome” which includes problems such as fever, bruising, nausea, and fatigue. Other risks associated with catheter insertion and the medications and embolizing materials delivered include:

While the actual TACE procedure takes only two hours, there is preparation work to do ahead of time. The patient’s oncologist will need to determine the type and dosing of chemotherapy to be delivered during the embolization process. Some types of chemotherapy require the patient to get a cardiac imaging test, called an echocardiogram, prior to the procedure to document the heart’s baseline functioning. A new or recent imaging test (typically CT or MRI) may also be required to understand the extent of tumor activity. The oncologist will also order bloodwork to measure liver and kidney function and other indicators, such as immune system function.

Patients will have detailed discussions with care team members about prescription drug usage. It is critical that any medications, particularly blood thinners, are paused in a safe, timely manner prior to undergoing TACE. Since sedation is used in TACE, the team will provide instructions explaining when to stop eating and drinking ahead of the procedure.

After recovering in a monitored observation area following TACE, patients usually stay overnight at the hospital for observation. Fluids and medications for pain or nausea are given to prevent or reduce these possible side effects. Typically, patients are discharged the following day and can resume daily activities within a week. Temporary fatigue and loss of appetite are not uncommon after TACE. Fever or pain may also present during the recovery period and can be treated with over-the-counter medications.

Subsequent liver imaging (usually a CT scan) will usually be ordered to see how the tumor size changes over time. If cancerous cells are still present, a second TACE may be scheduled.