Transarterial Chemoembolization (TACE)
Transarterial Chemoembolization (TACE): Overview, Mechanisms, and Applications
Transarterial chemoembolization (TACE) is a minimally invasive procedure used primarily to treat liver cancer, particularly non-resectable hepatocellular carcinoma (HCC). It combines the delivery of chemotherapy directly into the tumor’s blood supply with embolization to block blood flow, thereby starving the tumor of oxygen and nutrients. Below is a detailed overview of TACE, including its mechanisms, applications, and types.
Mechanisms of TACE
Chemotherapy Delivery:
- Chemotherapeutic agents are injected directly into the arteries feeding the tumor, ensuring high concentrations of drugs at the tumor site while minimizing systemic exposure[1][2].
Embolization:
- Embolic agents, such as gelatin sponges or drug-eluting beads (DEBs), are used to occlude the blood vessels supplying the tumor, reducing blood flow and trapping the chemotherapy within the tumor[3][5].
Dual Action:
- TACE attacks the tumor in two ways: by delivering a high concentration of chemotherapy and by cutting off the tumor’s blood supply, leading to ischemic necrosis[2][4].
Types of TACE
Conventional TACE (cTACE):
- Involves mixing chemotherapy with Lipiodol, an iodized oil, followed by mechanical embolization using agents like gelfoam or PVA particles[1][5].
Drug-Eluting Beads TACE (DEB-TACE):
- Uses beads loaded with chemotherapy drugs that slowly release the medication over time, potentially reducing side effects compared to cTACE[1][4].
Applications of TACE
- Primarily used for treating non-resectable hepatocellular carcinoma (HCC) when surgery or ablation is not feasible[1][4].
- May also be used for bridging therapy in patients awaiting liver transplantation[4].
Metastatic Disease:
- Can be applied to liver metastases from other cancers, though its use is less common for non-liver tumors[3][7].
Benefits and Risks
Benefits:
- Localized Treatment: Minimizes systemic side effects by delivering chemotherapy directly to the tumor.
- Minimally Invasive: Reduces recovery time compared to open surgeries.
- Effective for Non-Resectable Tumors: Provides a treatment option when surgical removal is not possible.
Risks:
- Liver Damage: Potential for liver dysfunction if not carefully monitored.
- Side Effects: Post-embolization syndrome (e.g., pain, fever, nausea) is common but usually temporary[6].
- Variable Efficacy: Outcomes can vary based on tumor size, location, and patient health status[4].
Conclusion
TACE is a valuable treatment strategy for liver cancer, offering a localized approach to deliver chemotherapy and block tumor blood supply. While it is primarily used for liver tumors, its applications can extend to other cancers with liver metastases. Ongoing research aims to optimize TACE protocols and reduce side effects.
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