TACE (transarterial chemoembolization) is a treatment technique used most commonly to treat unresectable (i.e., inoperable) hepatocellular (primary liver) cancer.
This procedure is appropriate in the setting where there is no evidence metastases or of invasion into any of the large arteries or veins of the liver, but where the size of the tumor is too large (> 5 cm) to be effectively treated by radiofrequency ablation (RFA).
TACE is performed by infusing a concentrated dose of drugs including chemotherapy, an emulsifier, an embolic agent into the branch of the hepatic artery feeding the area of the liver that contains the tumor.
Relative contraindications to TACE are obstruction of the portal vein, Childs-Pugh classification 3 (i.e., advanced liver disease), and serum bilirubin levels > 3 mg/dL.
Patients with these characteristics are sometimes considered as candidates for TACE given on a segmental (i.e., smaller anatomical) level.
Complications of TACE occur in about 10% of patients and include fever, cholecystitis (gallbladder inflammation), abdominal pain, nausea and vomiting, and loss of bone marrow function.
Risk of mortality is generally low and is estimated to be less than 5%.
While not providing definitive cure, TACE has been shown to improve survival, with one large study of more than 8000 patients showing the median time of survival to be 34 months with a one-year rate of 82% and a five-year rate of 26%.