Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-f554764f5-44mx8 Total loading time: 0 Render date: 2025-04-09T02:42:15.149Z Has data issue: false hasContentIssue false

16 - Transcatheter Arterial Chemoembolization: Technique and Future Potential

from PART III - ORGAN-SPECIFIC CANCERS

Published online by Cambridge University Press:  18 May 2010

By
Eleni Liapi ,
Christos S. Georgiades ,
Kelvin Hong  and
Jean-Francois H. Geschwind
Edited by
Jean-François H. Geschwind  and
Michael C. Soulen
Eleni Liapi
Affiliation:
Postdoctoral Research Fellow, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD
Christos S. Georgiades
Affiliation:
Assistant Professor, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD
Kelvin Hong
Affiliation:
Assistant Professor, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD
Jean-Francois H. Geschwind
Affiliation:
Professor of Radiology, Department of Radiology and Radiological Science Johns Hopkins University School of Medicine Baltimore, MD
Jean-François H. Geschwind
Affiliation:
The Johns Hopkins University School of Medicine
Michael C. Soulen
Affiliation:
University of Pennsylvania School of Medicine
Get access

Summary

Transcatheter arterial chemoembolization (TACE) is one of the most commonly performed procedures in interventional radiology and over the past 20 years, has significantly contributed to the evolution of this subspecialty (1, 2). TACE exploits the initial observation that most hepatic malignancies receive their blood supply largely by the hepatic artery, and selectively delivers intra-arterially high doses of chemotherapy to the tumor bed, while sparing the surrounding hepatic parenchyma (3, 4). Despite its promising design, TACE has not proved yet to be as effective as in theory. Several variations in the application of the technique, as well as the heterogeneity of chemotherapeutic regimens, are some of the most important challenges toward a thorough investigation of its clinical benefits (5). It is therefore essential for interventional radiologists to standardize the technique in order to maximize its effectiveness and help future advancements. In this chapter, we review the technical and clinical part of the procedure, as well as current results and future potential of TACE.

DEFINITION OF TACE, HISTORICAL BACKGROUND AND UNDERLYING PRINCIPLES OF TUMOR DAMAGE

TACE is defined as the infusion of a mixture of chemotherapeutic agents with or without iodized oil followed by embolization with particles (6). The technique was introduced in 1977 by Yamada, who intra-arterially delivered gelatin-sponge pieces permeated with 10 mg of mitomycin C or 20 mg of doxorubicin (Adriamycin), after super-selecting the tumor feeding artery of unresectable hepatomas (3, 4).

Type
Chapter
Information
Interventional Oncology
Principles and Practice
 , pp. 192 - 201
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Stuart, K. Chemoembolization in the management of liver tumors. Oncologist, 2003 October 1; 8(5): 425–437.CrossRefGoogle Scholar
Roche, A, Girish, B, Baere, T, et al. Trans-catheter arterial chemoembolization as first-line treatment for hepatic metastases from endocrine tumors. Eur Radiol, 2003; 13(1): 136.Google ScholarPubMed
Yamada, R, Nakatsuka, H, Nakamura, K, et al. Hepatic artery embolization in 32 patients with unresectable hepatoma. Osaka City Med J, 1980; 26(2): 81–96.Google ScholarPubMed
Yamada, R, Sato, M, Kawabata, M, et al. Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology, 1983 Aug; 148(2): 397–401.CrossRefGoogle Scholar
Geschwind, J F. Chemoembolization for hepatocellular carcinoma: Where does the truth lie?J Vasc Interv Radiol, 2002 Oct; 13(10): 991–994.CrossRefGoogle Scholar
Brown, D B, Gould, J E, Gervais, D A, et al. Transcatheter therapy for hepatic malignancy: Standardization of terminology and reporting criteria. J Vasc Interv Radiol, 2007; 18(12): 1469–1478.CrossRefGoogle ScholarPubMed
Nakakuma, K, Tashiro, S, Hiraoka, T, et al. Studies on anticancer treatment with an oily anticancer drug injected into the ligated feeding hepatic artery for liver cancer. Cancer, 1983 Dec 15; 52(12): 2193–2200.3.0.CO;2-R>CrossRefGoogle Scholar
Konno, T, Maeda, H, Iwai, K, et al. Effect of arterial administration of high-molecular-weight anticancer agent SMANCS with lipid lymphographic agent on hepatoma: A preliminary report. Eur J Cancer Clin Oncol, 1983 Aug;19; (8): 1053–1065.CrossRefGoogle Scholar
Clouse, M E, Perry, L, Stuart, K, et al. Hepatic arterial chemoembolization for metastatic neuroendocrine tumors. Digestion, 1994; 55 Suppl 3: 92–97.CrossRefGoogle ScholarPubMed
Xiong, Z P, Yang, S R, Liang, Z Y, et al. Association between vascular endothelial growth factor and metastasis after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int, 2004 Aug; 3(3): 386–390.Google Scholar
Kobayashi, N, Ishii, M, Ueno, Y, et al. Co-expression of Bcl-2 protein and vascular endothelial growth factor in hepatocellular carcinomas treated by chemoembolization. Liver, 1999 Feb; 19(1): 25–31.CrossRefGoogle Scholar
Sergio, A, Cristofori, C, Cardin, R, et al. Transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC): The role of angiogenesis and invasiveness. Am J Gastroenterol, 2008 Jan 2 [Epub ahead of print].CrossRefGoogle Scholar
Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire. A comparison of lipiodol chemoembolization and conservative treatment for unresectable hepatocellular carcinoma. N Engl J Med, 1995 May 11; 332(19): 1256–1261.CrossRef
Lo, C M, Ngan, H, Tso, W K, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology, 2002 May; 35(5): 1164–1171.CrossRefGoogle Scholar
Llovet, J M, Real, M I, Montana, X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: A randomised controlled trial. Lancet, 2002 May 18; 359(9319): 1734–1739.CrossRefGoogle Scholar
Aoki, T, Imamura, H, Hasegawa, K, et al. Sequential preoperative arterial and portal venous embolizations in patients with hepatocellular carcinoma. Arch Surg, 2004; 139(7): 766–774.CrossRefGoogle ScholarPubMed
Llovet, J M, Burroughs, A, and Bruix, J. Hepatocellular carcinoma. Lancet, 2003 Dec 6; 362(9399): 1907–1917.CrossRefGoogle Scholar
Llovet, J M. Treatment of hepatocellular carcinoma. Curr Treat Options Gastroenterol, 2004 Dec; 7(6): 431–441.CrossRefGoogle Scholar
Arii, S, Yamaoka, Y, Futagawa, S, The Liver Cancer Study Group of Japan. et al. Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: A retrospective and nationwide survey in Japan. Hepatology, 2000 Dec; 32(6): 1224–1229.CrossRefGoogle Scholar
Livraghi, T, Meloni, F, Morabito, A, et al. Multimodal image-guided tailored therapy of early and intermediate hepatocellular carcinoma: Long-term survival in the experience of a single radiologic referral center. Liver Transpl, 2004 Feb; 10(2 Suppl 1): S98–106.CrossRefGoogle Scholar
Burger, I, Hong, K, Schulick, R, et al. Transcatheter arterial chemoembolization in unresectable cholangiocarcinoma: Initial experience in a single institution. J Vasc Interv Radiol, 2005 Mar; 16(3): 353–361.CrossRefGoogle Scholar
Liapi, E, Geschwind, J F, Vossen, J A, et al. Functional MRI evaluation of tumor response in patients with neuroendocrine hepatic metastasis treated with transcatheter arterial chemoembolization. AJR Am J Roentgenol, 2008 Jan; 190(1): 67–73.CrossRefGoogle Scholar
Sullivan, K L. Hepatic artery chemoembolization. Semin Oncol, 2002 Apr; 29(2): 145–151.CrossRefGoogle Scholar
Vogl, T J, Zangos, S, Eichler, K, et al. Colorectal liver metastases: Regional chemotherapy via transarterial chemoembolization (TACE) and hepatic chemoperfusion: An update. Eur Radiol, 2007 Apr; 17(4): 1025–1034.CrossRefGoogle Scholar
Georgiades, C S, Liapi, E, Frangakis, C, et al. Prognostic accuracy of 12 liver staging systems in patients with unresectable hepatocellular carcinoma treated with transarterial chemoembolization. J Vasc Interv Radiol, 2006 October 1; 17(10): 1619–1624.CrossRefGoogle Scholar
Chung, J W, Park, J H, Han, J K, et al. Hepatocellular carcinoma and portal vein invasion: Results of treatment with transcatheter oily chemoembolization. Am J Roentgenol, 1995 August 1; 165(2): 315–321.CrossRefGoogle Scholar
Georgiades, C S, Hong, K, D'Angelo, M, et al. Safety and efficacy of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma and portal vein thrombosis. J Vasc Interv Radiol, 2005 December 1; 16(12): 1653–1659.CrossRefGoogle Scholar
Kamel, I R, Bluemke, D A, Ramsey, D, et al. Role of diffusion-weighted imaging in estimating tumor necrosis after chemoembolization of hepatocellular carcinoma. Am J Roentgenol, 2003, Sept; 181(3): 708–710.CrossRefGoogle Scholar
Kothary, N, Weintraub, J L, Susman, J, et al. Transarterial chemoembolization for primary hepatocellular carcinoma in patients at high risk. J Vasc Interv Radiol, 2007; 18(12): 1517–1526.CrossRefGoogle ScholarPubMed
Bruix, J, Sala, M, and Llovet, J M. Chemoembolization for hepatocellular carcinoma. Gastroenterology, 2004 Nov; 127(5 Suppl 1): S179–188.CrossRefGoogle Scholar
Jaeger, H J, Mehring, U M, Castaneda, F, et al. Sequential transarterial chemoembolization for unresectable advanced hepatocellular carcinoma. Cardiovasc Intervent Radiol, 1996 Nov–Dec; 19(6): 388–396.CrossRefGoogle Scholar
Geschwind, J F, Ramsey, D E, Wal, B C, et al. Transcatheter arterial chemoembolization of liver tumors: Effects of embolization protocol on injectable volume of chemotherapy and subsequent arterial patency. Cardiovasc Intervent Radiol, 2003 Mar–Apr; 26(2): 111–117.CrossRefGoogle Scholar
Liapi, E, Georgiades, C C, Hong, K, et al. Transcatheter arterial chemoembolization: current technique and future promise. Tech Vasc Interv Radiol, 2007 Mar; 10(1): 2–11.CrossRefGoogle Scholar
Liapi, E, Hong, K, Georgiades, C S, et al. Three-dimensional rotational angiography: Introduction of an adjunctive tool for successful transarterial chemoembolization. J Vasc Interv Radiol, 2005 Sept; 16(9): 1241–1245.CrossRefGoogle Scholar
Okuda, K, Musha, H, Yamasaki, T, et al. Angiographic demonstration of intrahepatic arterio-portal anastomoses in hepatocellular carcinoma. Radiology, 1977 Jan 1; 122(1): 53–58.CrossRefGoogle Scholar
Hong, K, Liapi, E, Georgiades, C S, et al. Case-controlled comparison of a percutaneous collagen arteriotomy closure device versus manual compression after liver chemoembolization. J Vasc Interv Radiol, 2005 March 1; 16(3): 339–345.CrossRefGoogle Scholar
Therasse, P, Arbuck, S G, Eisenhauer, E A, et al. New guidelines to evaluate the response to treatment in solid tumors: European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst, 2000 Feb 2; 92(3): 205–216.CrossRefGoogle Scholar
Tsuchida, Y and Therasse, P. Response evaluation criteria in solid tumors (RECIST): New guidelines. Med Pediatr Oncol, 2001 Jul; 37(1): 1–3.CrossRefGoogle Scholar
Murakami, R, Yoshimatsu, S, Yamashita, Y, et al. Treatment of hepatocellular carcinoma: Value of percutaneous microwave coagulation. AJR Am J Roentgenol, 1995 May; 164(5): 1159–1164.CrossRefGoogle Scholar
Castrucci, M, Sironi, S, Cobelli, F, et al. Plain and gadolinium-DTPA-enhanced MR imaging of hepatocellular carcinoma treated with transarterial chemoembolization. Abdom Imaging, 1996 Nov–Dec; 21(6): 488–494.CrossRefGoogle Scholar
Bartolozzi, C, Lencioni, R, Caramella, D, et al. Treatment of hepatocellular carcinoma with percutaneous ethanol injection: Evaluation with contrast-enhanced MR imaging. AJR Am J Roentgenol, 1994 Apr; 162(4): 827–831.CrossRefGoogle Scholar
Lim, H K and Han, J K. Hepatocellular carcinoma: Evaluation of therapeutic response to interventional procedures. Abdom Imaging, 2002 Mar–Apr; 27(2): 168–179.CrossRefGoogle Scholar
Takayasu, K, Ar, S ii, Matsuo, N, et al. Comparison of CT findings with resected specimens after chemoembolization with iodized oil for hepatocellular carcinoma. AJR Am J Roentgenol, 2000 Sep; 175(3): 699–704.CrossRefGoogle Scholar
Bruix, J, Llovet, J M, Castells, A, et al. Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: Results of a randomized, controlled trial in a single institution. Hepatology, 1998 Jun; 27(6): 1578–1583.CrossRefGoogle Scholar
Livraghi, T, Giorgio, A, Marin, G, et al. Hepatocellular carcinoma and cirrhosis in 746 patients: Long-term results of percutaneous ethanol injection. Radiology, 1995 Oct; 197(1): 101–108.CrossRefGoogle Scholar
Simonetti, R G, Liberati, A, Angiolini, C, et al. Treatment of hepatocellular carcinoma: A systematic review of randomized controlled trials. Ann Oncol, 1997 Feb; 8(2): 117–136.CrossRefGoogle Scholar
Gupta, S, Johnson, M M, Murphy, R, et al. Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors. Cancer, 2005; 104(8): 1590–1602.CrossRefGoogle ScholarPubMed
Lang, E K and Brown, C L Jr.Colorectal metastases to the liver: Selective chemoembolization. Radiology, 1993 November 1; 189(2): 417–422.CrossRefGoogle Scholar
Geschwind, J F, Khwaja, A, and Hong, K. New intraarterial drug delivery system: Pharmacokinetics and tumor response in an animal model of liver cancer. ASCO Annual Meeting, 2005, Orlando, Florida.Google Scholar
Varela, M, Real, M I, Burrel, M, et al. Chemoembolization of hepatocellular carcinoma with drug eluting beads: Efficacy and doxorubicin pharmacokinetics. J Hepatol, 2007; 46(3): 474–481.CrossRefGoogle ScholarPubMed
Reyes, D, Geschwind, J-FH. Intraarterial doxorubicin-eluting microspheres for patients with unresectable hepatocellular carcinoma: A pilot study. CIRSE, 2007; Athens, Greece: European Society of Cardiovascular Interventional Radiology, 2007, p. 16.Google Scholar
Poon, R T, Tso, W K, Pang, R W, et al. A phase I/II trial of chemoembolization for hepatocellular carcinoma using a novel intra-arterial drug-eluting bead. Clin Gastroenterol Hepatol, 2007 Sep; 5(9): 1100–1108.CrossRefGoogle Scholar
Yoshizawa, H, Nishino, S, Shiomori, K, et al. Surface morphology control of polylactide microspheres enclosing irinotecan hydrochloride. Int J Pharm, 2005; 296(1–2): 112–116.CrossRefGoogle ScholarPubMed
Aliberti, C, Tilli, M, Benea, G, et al. Trans-arterial chemoembolization (TACE) of liver metastases from colorectal cancer using irinotecan-eluting beads: Preliminary results. Anticancer Res, 2006 Sep–Oct; 26(5B): 3793–3795.Google Scholar
Ferrara, N and Henzel, W J. Pituitary follicular cells secrete a novel heparin-binding growth factor specific for vascular endothelial cells. Biochem Biophys Res Commun, 1989 Jun 15; 161(2): 851–858.CrossRefGoogle Scholar
Wang, Y, Fei, D, Vanderlaan, M, et al. Biological activity of bevacizumab, a humanized anti-VEGF antibody in vitro. Angiogenesis, 2004; 7(4): 335.CrossRefGoogle ScholarPubMed
Motl, S. Bevacizumab in combination chemotherapy for colorectal and other cancers. Am J Health Syst Pharm, 2005 May; 62(10): 1021–1032.Google Scholar
Food and Drug Administration. Bevacizumab FDA approval letter, 2004.
Kim, K J, Li, B, Winer, J, Armanini, M, et al. Inhibition of vascular endothelial growth factor-induced angiogenesis suppresses tumour growth in vivo. Nature, 1993 Apr 29; 362(6423): 841–844.CrossRefGoogle Scholar
Cobleigh, M A, Langmuir, V K, Sledge, G W, et al. A phase I/II dose-escalation trial of bevacizumab in previously treated metastatic breast cancer. Semin Oncol, 2003 Oct; 30(5Suppl 16): 117–124.CrossRefGoogle Scholar
Yang, J C, Haworth, L, Sherry, R M, et al. A randomized trial of bevacizumab, an anti-vascular endothelial growth factor antibody, for metastatic renal cancer. N Engl J Med, 2003 July 31; 349(5): 427–434.CrossRefGoogle Scholar
Imaeda, T, Kanematsu, M, Mochizuki, R, et al. Extracapsular invasion of small hepatocellular carcinoma: MR and CT findings. J Comput Assist Tomogr, 1994 Sept–Oct; 18(5): 755–760.CrossRef
Yamaguchi, R, Yano, H, Iemura, A, et al. Expression of vascular endothelial growth factor in human hepatocellular carcinoma. Hepatology, 1998 Jul; 28(1): 68–77.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Transcatheter Arterial Chemoembolization: Technique and Future Potential
    • By Eleni Liapi, Postdoctoral Research Fellow, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Christos S. Georgiades, Assistant Professor, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Kelvin Hong, Assistant Professor, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Jean-Francois H. Geschwind, Professor of Radiology, Department of Radiology and Radiological Science Johns Hopkins University School of Medicine Baltimore, MD
  • Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
  • Book: Interventional Oncology
  • Online publication: 18 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511722226.017
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Transcatheter Arterial Chemoembolization: Technique and Future Potential
    • By Eleni Liapi, Postdoctoral Research Fellow, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Christos S. Georgiades, Assistant Professor, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Kelvin Hong, Assistant Professor, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Jean-Francois H. Geschwind, Professor of Radiology, Department of Radiology and Radiological Science Johns Hopkins University School of Medicine Baltimore, MD
  • Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
  • Book: Interventional Oncology
  • Online publication: 18 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511722226.017
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Transcatheter Arterial Chemoembolization: Technique and Future Potential
    • By Eleni Liapi, Postdoctoral Research Fellow, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Christos S. Georgiades, Assistant Professor, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Kelvin Hong, Assistant Professor, Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology Johns Hopkins University School of Medicine Baltimore, MD, Jean-Francois H. Geschwind, Professor of Radiology, Department of Radiology and Radiological Science Johns Hopkins University School of Medicine Baltimore, MD
  • Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
  • Book: Interventional Oncology
  • Online publication: 18 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511722226.017
Available formats
×