Chemo Infusion and Chemoembolization of Liver

1 What are Chemo Infusion and Chemoembolization of Liver?

Arterial chemotherapy infusion of the liver and chemoembolization of the liver (transarterial chemoembolization or TACE) are similar procedures that are used for the treatment of liver cancers because, in both procedures, chemotherapy is injected into the hepatic (liver) artery that supplies the liver tumor.

The difference between the two procedures is that in chemoembolization, additional material is injected to block (embolize) the small branches of the hepatic artery.

Chemotherapy is injected into the hepatic artery because the normal liver gets its blood supply from the portal vein and the hepatic artery and a primary liver cancer (hepatoma or hepatocellular carcinoma (HCC)) gets its blood exclusively from the hepatic artery.

Side effects can be inflammation of the gallbladder (cholecystitis), intestinal and stomach ulcers, and inflammation of the pancreas (pancreatitis) and HCC patients with advanced cirrhosis may develop liver failure after this treatment.

The benefit of intra-arterial chemotherapy is that fewer than 50% of HCC patients will experience a reduction in tumor size.

An interventional radiologist (one who does therapeutic procedures) usually carries out this procedure but an oncologist (cancer specialist) determines the amount of chemotherapy that the patient receives at each session – some patients may undergo repeat sessions at six- to 12-week intervals.

This procedure is done with the help of fluoroscopy ( a type of x-ray) imaging because a catheter (long, narrow tube) is inserted into the femoral artery in the groin and is threaded into the aorta (the main artery of the body) and then from the aorta into the hepatic artery. The whole procedure takes one to two hours, and then the catheter is removed.

After the procedure, the patient generally stays in the hospital overnight for observation and a sandbag is placed over the groin to compress the area where the catheter was inserted into the femoral artery.

Generally, the liver tests get worse during the two to three days after the procedure but this is due to the death of the tumor (and some non-tumor) cells. During this time, the patient may experience some post-procedure abdominal pain and low-grade fever.

Severe abdominal pain and vomiting suggest that a more serious complication has developed. Imaging studies of the liver are repeated in six to 12 weeks to assess the size of the tumor in response to the treatment.

Chemoembolization (TACE) is similar to intra-arterial infusion of chemotherapy but in TACE, there is the additional step of blocking (embolizing) the small blood vessels with different types of compounds, such as gel foam or even small metal coils and TACE has the advantages of exposing the tumor to high concentrations of chemotherapy and confining the agents locally since they are not carried away by the bloodstream.

In the U.S., trials are underway to see whether doing TACE before liver transplantation increases patient survival as compared to liver transplantation without TACE because in one large study involving several institutions in Italy, chemoembolization did not seem to be beneficial because patients who did not undergo TACE lived as long as patients who received TACE, even though the tumors were more likely to shrink in size in patients who were treated.

Studies in Japan have shown that TACE can downstage HCC (the tumors shrank enough to lower the stage of cancer so shrinking the tumor creates the option for surgery in some of the patients who had tumors that were not operable (eligible for operation) because of the initial large size of their tumors.

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