Hepatic arterial therapy exploits the fact that tumors are almost exclusively fed by the hepatic artery, while normal liver tissue is mostly supplied by the portal vein.
The above difference in blood supply allows for a highly selective embolization of , and cytotoxic drug delivery to, tumors with relative spearing of surrounding normal tissue.
Embolization of the vascular supply leads to ischemic necrosis of tumor tissues while slowing wash out of chemotherapy agents, allowing higher levels of drug delivery to target tissues than would be possible with systemic therapy.
During the TACE procedure an angiographic catheter is advanced into branches of the hepatic artery supplying the tumor, and chemotherapeutic agents, typically mixed with an oily contrast agent are injected following followed by permanently occlusive embolic particles.
Typical agents use are chemotherapy drugs doxorubicin, and cis-platinum, and contrast agents lipoidol, or ethiodol.
Occlusive embolic particles are carried into the terminal hepatic arterioles which occlude the vessels resulting in ischemic tumor necrosis.
TACE standard of care for patients with intermediate stage disease with multinodular lesions but without vascular invasion.
TACE exploits the difference in blood supply to the normal liver with the normal liver being perfused by both the portal vein and the hepatic artery.
Liver metastases derive most of their blood supply from the hepatic artery allowing devascularization as a target for treatment, as healthy hepatocytes derived most of their blood supply from the portal vein.
TACE standard of care for patients with intermediate stage hepatoma disease with multinodular lesions but without vascular invasion.
TACE exploits the difference in blood supply to the normal liver with the normal liver being perfused by both the portal vein and the hepatic artery.
Hepatoma derived its blood supply almost entirely from the hepatic artery.
Utilized when significant liver metastases are present in colorectal cancer when the lesions are not amenable to surgery.
CE with doxorubicin and ethiodized oil to treat 46 patients with unresectable colon hepatic metastases resulting in a complete response in 24% patients (Lang EK, Brown CL).
In a phase II trial of 30 patients with liver metastases from colorectal cancer treated with CE with cis-platinum, doxorubicin, and mitomycin C resulted in a radiologic response of 63%, or a biological response with a decrease in CEA levels, and either response by 82% of patients. (tellez C et al).
In a phase II trial CE on 40 patients with 5-FU, mitomycin, ethiodized oil, and gelatine sponge embolization and 22.8% partial response was seen (Sanz-Altimara PS et al).
In a study of 463 patients treated with chemoembolization with mitomycin-C alone, mitomycin C. and gemcitabine, or mitomycin and irinotecan, followed by Lipiodol and starch microspheres was associated with a partial response of 14.7%, stable disease 48.2% and progressive disease and 37.1% with a median survival of 38 months from the diagnosis of liver metastasis and 14 months from the start of CE (Vogel TJ et al).
CE with cis-platinum, doxorubicin, mitomycin C, ethiodized oil, polyvinyl alcohol particles at monthly intervals for 1-4 sessions for 121 patients with metastatic liver disease from colorectal cancer resulted in local control after 43% of the treatment cycles with a median survival of 27 months in 11 months after initiation of salvage treatment after failure of second line therapy: 2% partial response 41% stable disease, and 54% progression (Albert M et al).
Hepatic arterial embolization is utilized in patients with neuroendocrine tumors with symptoms difficult to control with somatostatin analog treatment, radiographic evidence of progressive disease, and/or large tumor burden.
Transcatheter arterial chemoembolization (TACE) can improve three-year survival rates from 10% to 40-50% with a median survival duration of 16-20 months in hepatocellular carcinoma.(Cabrera R, Nelson DR).
TACE in hepatoma associated with a two-year improved overall survival compared with conservative treatment.
Post embolization syndrome with transient fever, abdominal pain, nausea elevated LFTs are side effects related to the procedure along with fatigue, and vomiting.