Colorectal liver metastases
- Delivers chemotherapy (conventional TACE or drug-eluting beads — DEB-TACE) directly to the tumour via hepatic artery, combined with embolization
- In CRLM, generally considered palliative rather than curative intent
- ESMO guidelines: TACE should be used in CRLM for non-curative intent in patients with multiple metastases
- Best used in patients not suitable for ablation or SBRT, or as a bridge to other therapies
Hepatocellular carcinoma
- TACE - Selective infusion of embolizing particles coupled or not with cytotoxic agents or for the intraarterial infusion of radioactive isotopes
- doxorubicin or epirubicin, and/or cisplatin or miriplatin
- Emulsion of cytotoxic agents with lipiodol followed by spongostan
- HCC receives 100% of blood supply from the artery
- Occasionally need to embolise diaphragmatic or mammary arteries to achieve adequate control.
- Iodised oil injection combined to improve efficacy. Retained in malignant tumours (cleared from normal hepatic parenchyma), may be used for targeting cytotoxic drugs.
- Contraindications:
- Liver decompensation
- Biliary obstruction
- Bilioenteric anastomosis
- Impaired kidney function
- Portal vein thrombosis (unless limited to section of liver only)
- Morbidity:
- 75% develop post embolization syndrome – fever, abdominal pain, nausea and raised serum transaminase levels. Self-limiting.
- More severe complications: cholecystitis or GB infarction, gastric/duodenal wall necrosis & pancreatitis. Hepatic abscess rare.
- Monitoring:
- CT 1 month – can see disappearance of arterial vascular supply to tumour and decrease in diameter.
- Efficacy:
- Improves survival. Median 34 months Japanese study.
- Predictors of survival:
- Degree of liver damage
- Portal vein invasion
- Maximum tumour size
- Number of lesions
- AFP levels
- Patients with liver-only HCC without vascular invasion who are not amenable to resection, transplantation, or ablation should be considered for intra-arterial therapies