Transarterial Chemoembolization

Primary liver cancer is one of the most frequently diagnosed malignancies worldwide; it is the second leading cause of cancer death worldwide. Seventy to 90% of primary liver cancer is hepatocellular carcinoma (HCC), most often occurring in the patients with chronic liver disease and cirrhosis. HCC has characteristic features on CT/MRI: (1) arterial phase enhancement and (2) portal venous/delayed phase washout. Multiple staging systems exist for patients with HCC; the most common in the western hemisphere is the Barcelona Clinic Liver Cancer (BCLC) staging system. BCLC uses tumor burden, patients’ clinical status, and serum laboratory values to provide treatment recommendations. Conventional therapy includes the curative surgical resection or transplant, though these are often limited by tumor burden. Transarterial chemoembolization (TACE) involves direct injection of chemotherapeutic agent(s) and embolic materials directly into the artery supplying the tumor. The chemotherapy is often mixed with iodized oil (cTACE), calibrated microspheres, or drug-eluting embolics (DEE-TACE). The particular regimen is adjusted per operator preference and each patient’s clinical status and tumor burden. After TACE patients often experience transient nausea and pain, entitled post-embolization syndrome. This is usually well controlled with medications. A multi-disciplinary approach is recommended when it comes to the treatment and follow-up of these complex patients.