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TACE – Standard of Care for Hepatocellular Carcinoma

TACE therapy

Transarterial chemoembolization (TACE) combines the effect of regional chemotherapy with the effect of ischemic necrosis induced by arterial embolization. TACE cancer treatment takes advantage of the fact that the perfusion of hepatocellular carcinomas (HCC) and liver metastases from other types of cancer is for the most part through hepatic arteries, opening up the option for interventional radiologists to selectively deliver anti-tumor substances through the arteries.

 

It is performed as a catheter-based angiographic procedure using real time image guidance to ensure optimal outcome. The combination of regional chemotherapy and embolization ensures synergistic anti-tumor effects while at the same time reducing systemic drug levels and thereby toxicity.
While TACE cancer treatment is considered standard of care in the treatment of advanced and non-resectable cases of HCC, it is also playing an important role as a bridging therapy until a liver transplant is available in localized HCC. In addition to treatment of HCC, it is also performed in patients with liver metastases of colorectal tumors or neuroendocrine tumors.
Applying advanced imaging techniques a higher selectivity of TACE cancer treatment (lobar versus segmental versus subsegmental) can be ensured with the effect of improved efficacy and tolerance of the procedure.
TACE therapy is usually applied several times at fixed intervals in order to control cancer growth. Using image guided therapy delivery, some of the specific toxicities that can result from TACE treatment can be minimized. This allows an overall positive impact on patient survival and quality of life.

Patient selection – crucial for success

  • The following criteria provide an indication for TACE cancer treatment:
  • The patient has advanced HCC but no metastatic spread and is not a candidate for resection
  • The patient with HCC is a candidate for bridging until a liver transplant is available
  • The patient still has sufficient remaining liver function
  • The patient has multiple liver metastases from other types of cancer such as colorectal cancer which are not resectable and refractory to standard systemic therapy

 


Major role of image guidance during procedure

TACE therapy
  • Plan and perform the procedure based on state of the art imaging technology
  • Base cancer staging and stratification for TACE cancer treatment on CT or MRI examinations
  • Locate all feeding arteries of the tumor, including extrahepatic arteries, and determine the extent of portal vein involvement with thorough angiographic examination
  • Provide objective measurement e.g. of the contrast enhanced viable part of the residual tumor tissue after TACE treatment by imaging, using it as a predictor of radiologic treatment response
  • Assess therapy effect after successful TACE treatment by applying different kinds of response criteria such as the Response Evaluation Criteria In Solid Tumors (RECIST) or the criteria of the European Association for the Study of the Liver (EASL) based on imaging
  • Apply response-guided treatment strategies as opposed to fixed schedules through image-based response evaluation

 

TACE therapy

Siemens angiography and advanced applications help guide TACE cancer treatment:

  • Greater positioning flexibility and easy patient access with Artis zeego, a robotic assisted angiographic system
  • Visualization of tumor feeding vessels and lesions through 3D CT-like images in the angio suite with syngo DynaCT
  • Advanced embolization planning and guidance with syngo Embolization Guidance
  • Evaluation of treatment response by assessing perfusion volume with syngo DynaPBV Body

 

Related Information about Interventional Oncology

Tumor therapies in interventional oncology
Advanced applications for interventional oncology
1.European Association For The Study Of The Liver, European Organisation For Research Treatment Of Cancer: EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56: 908-943
2.Bruix J, Sherman M, American Association for the Study of Liver Disease: Management of hepatocellular carcinoma: an update. Hepatology 2011; 53: 1020-1022
3.Llovet JM, Bruix J: Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 2003; 37: 429-442
4.Sieghart W, Hucke F, Peck-Radosavljevic M: Transarterial chemoembolisation: modalities, indication and patient selection. J Hepatology 2015; 62 (5): 1187-1195
5.Lovet JM, Real MI, Montana X, et al.: Arterial embolisation or chemoembolisation vs. symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002; 359: 1734-1739
6.Lo CM, Ngan H, Tso WK, et al.: Randomized
controlled trial of transarterial lipiodol chemoembolization for unresectable
hepatocellular carcinoma. Hepatology 2002; 35: 1164-1171
7.Bouvier A, Ozenne V, Aube C, et al.: Transarterial chemoembolisation: effect of selectivity on tolerance, tumour response and survival. Eur Radiol 2011; 21: 1719-1726
8.Malagari K, Pomoni M, Kelekis A, et al.: Prospective randomized comparison of chemoembolization with doxorubicin-eluting beads and bland embolization with BeadBlock for hepatocellular carcinoma. Cardiovasc Intervent Radiol 2010; 33: 541-551
9.Sherman M, Colombo M, Roberts L, et al.: Observations of hepatocellular carcinoma (HCC) management patterns from the global HCC bridge study: First characterization of the full study population. In: Book of abstracts – ILCA annual conference 2012; Abstr. #0-011
10.Bolondi L, Burroughs A, Dufour JF, et al.: Heterogeneity of patients with intermediate (BCLC B) Hepatocellular Carcinoma: proposal for a subclassification to facilitate treatment decisions. Semin Liver Dis 2012; 32: 348-359
11.Raoul JL, Sangro B, Forner A, et al.: Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization. Cancer Treat Rev 2011; 37: 212-22

 

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