Tace

Acronym for "transarterial chemoembolization". TACE describes a minimally invasive procedure in which a chemotherapeutic agent is selectively introduced into a tumour area under the control of imaging techniques. The nutritive peritumoral vessels are then embolized. TACE enables a chemotherapeutic agent (e.g. fluorodeoxyuridine, mitomycin C ) to have a localised effect and also protects the entire organism.

TACE is mainly used for tumours of the liver (e.g. HCC or liver metastases of other malignancies):

• If the Milan criteria are observed, TACE is a potentially curative therapy for HCC.
• Bridging measures until transplantation (LTX)
• However, the procedure is often used in a stage of the disease in which only palliative and life-prolonging therapy is the goal and a complete cure is no longer possible.

In principle, TACE is a treatment procedure that can be carried out several times. The therapy interval is between 4 weeks and 3 months depending on tolerance and toxic side effects. A continuation of TACE is indicated if vital hypervascularized tumor foci persist after initial response or new tumor foci appear and no contraindications exist. TACE should be continued repetitively until all tumor sites are devascularized. This can be checked by means of cross-sectional imaging. Due to the typical perfusion pattern of HCC, multiphase CT or MRI examinations with at least one arterial and one portal-venous contrast phase are necessary. In MRI examinations, necrotic and vital tumor parts can be differentiated more precisely than in CT, but only with optimal image quality. If tumor progression is apparent and there is no response to TACE, it must be stopped and the feasibility of other therapeutic options must be examined.

Portal vein thrombosis

Healthy liver tissue is supplied 75% via the portal vein system and only 25% via the hepatic artery. Liver tumours, on the other hand, are supplied up to 95% via the hepatic arteries.

1. Doci R et al (1988) Intrahepatic chemotherapy for unresectable hepatocellular carcinoma. Cancer 61: 1983-1987
2. Ikeda M et al (2004) Transcatheter arterial chemotherapy with and without embolization in patients with hepatocellular carcinoma. Oncology 66: 24-31.
3. Lammer J et al (2010) Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 33: 41-52
4. Marelli L et al (2007) Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol 30: 6-25