Transarterial chemoembolization (TACE) for hepatocellular carcinoma

1. What is TACE?

• This is an endovascular intervention (performed within the blood vessels) to treat hepatocellular carcinoma or in combination with other treatment methods to achieve the best possible treatment outcomes.
• This is a non-curative treatment that can be repeated multiple times until the desired outcome is achieved.

2. Which patients are indicated for TACE?

• Patients with intermediate-stage hepatocellular carcinoma (BCLC B) according to the Barcelona Clinic Liver Cancer staging system. These include cases with multifocal tumors (more than 3 tumors and/or tumors larger than 3 cm) and solitary tumors larger than 5 cm, without invasion of the main portal vein.
• To reduce tumor size before surgery
• For the diagnosis and treatment of early-stage tumors (tumors smaller than 1 cm)
• To temporarily control the tumor while waiting for the next step (portal vein embolization, liver transplantation)

3. What are the requirements for performing TACE?

• The patient's liver function must be preserved:
• Child-Pugh A, B; considered in Child-Pugh C
• AST, ALT ≤ 100 IU/mL
• Total bilirubin ≤ 2.5 mg%
• Renal function must allow the use of contrast media. When renal function is abnormal, the patient will be evaluated by a nephrologist to determine whether TACE can be performed.

4. How does TACE destroy liver cancer cells?

• Differences in the blood supply of hepatocellular carcinoma and normal liver tissue:
• Normal liver: 25% from the hepatic artery, 75% from the portal vein
• Hepatocellular carcinoma: approximately 100% from the hepatic artery. This is an important basis for treating hepatocellular carcinoma with TACE.
• Goals of TACE:
• Concentrate a high drug concentration within the tumor
• Prolong the contact time between the drug and the tumor
• Minimize systemic toxicity of the drug
• Reduce tumor size and growth rate

5. How long can TACE prolong survival?

• TACE prolongs survival in patients with unresectable hepatocellular carcinoma from 19 to 20 months (compared with a median survival of 16 months without treatment).
• The 1-, 2-, and 3-year survival rates are 96%, 77%, and 47%, respectively (compared with 57%, 31%, and 26% without treatment).

6. Is TACE dangerous?

• The complication rate is less than 5%, including hepatic decompensation, liver abscess, parenchymal infarction, arterial aneurysm, pulmonary embolism, ischemic or necrotic cholecystitis, liver rupture, and gastric or duodenal ulcers.
• Post-embolization syndrome: fever, abdominal pain, and moderate ileus occur in approximately 50% of patients after TACE. This syndrome is self-limiting and resolves within 48 hours.
• Complications related to contrast media, such as allergic reactions and renal impairment, are rare.
• The mortality rate related to TACE is less than 5%.

7. What should patients prepare before TACE?

• After TACE is indicated, the patient will undergo additional necessary tests to assess their overall condition (heart, lungs, kidneys, etc.) and evaluate potential risks associated with TACE.
• The physician will counsel the patient about the TACE procedure before it is performed, including how the procedure is performed, potential adverse events and complications, and the expected treatment outcomes.
• Patients need to fast for 6 hours before TACE and clean the groin area, as this is the access site for the procedure. Nurses will provide instructions on preparation.

8. What happens after TACE?

• During TACE:
• The patient will be asked to hold their breath for 10–15 seconds for imaging. When instructed by the physician, the patient should try to hold their breath as well as possible to obtain the clearest images. This is very important for locating the tumor.
• The patient may experience mild to severe pain due to the occlusion of blood vessels. The larger the tumor, the more likely pain is to occur.
• Some patients may experience nausea or vomiting due to the effects of chemotherapy drugs.
• After TACE:
• The patient will have a compression dressing applied to the arterial puncture site, usually the right thigh, and in some cases the left thigh. The compression dressing must remain in place for at least 8 hours. During this time, the patient must not remove the dressing, bend the thigh, sit up abruptly, or walk until it has been removed by healthcare staff.
• Patients may experience pain and a low-grade fever after TACE. These symptoms may persist and gradually subside within 2 weeks after TACE.
• Loss of appetite is very common after TACE. Some patients may experience hair loss due to the side effects of chemotherapy drugs.
• Patients are usually discharged one day after TACE. Patients who experience severe pain or adverse events or complications may need to remain hospitalized longer for further monitoring.

9. How is follow-up performed after TACE?

• The effectiveness of TACE is assessed using an abdominal CT scan 4–6 weeks after the procedure according to RECIST criteria.
• In cases of complete response: follow-up is performed every 4–6 weeks. No further TACE is required if complete tumor necrosis has been achieved on abdominal CT.
• Patients are indicated for repeat intervention if a complete response is not achieved or if recurrent tumor activity is detected.

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.