TACE: Transarterial chemoembolisation for hepatocellular carcinoma

Local interventional procedures are being used in primary and secondary liver tumours. How does transarterial chemoembolisation work in HCC?

For whom and how does TACE work?

Transarterial chemoembolization (TACE) is an established treatment option for patients with hepatocellular carcinoma (HCC).1 HCC is the most common liver malignancy and usually occurs in patients with cirrhosis and/or hepatitis. Currently, TACE is recommended from intermediate stage (BCLC stage B, Child-Pugh A/B) in the Barcelona Staging guidelines.2 

In TACE, cytostatic drugs are applied locally in the vessels that supply the tumour. Doxorubicin and mitomycin C are approved for HCC treatment. The cytostatic drugs are mixed with embolisation particles so that the blood flow is slowed down and the chemotherapy stays longer in the tumour tissue. This leads to a reduction in tumour size and an increase in survival time and improvement of symptoms.

One of the most important considerations in TACE is patient selection. The European guidelines recommend TACE for patients with inoperable HCC whose liver function is still relatively good. Patients with advanced HCC and liver dysfunction should consider alternative treatment options, such as selective internal radiotherapy (SIRT) or immunotherapy.2

TACE can be used either as a stand-alone therapy or in combination with other therapies such as radiofrequency ablation or surgery. In patients with large tumours, TACE can be used to shrink the tumour before surgery to reduce the risk of complications.

What to keep in mind for patients who receive TACE on a regular basis?

TACE is a safe treatment option, but as with all medical procedures, complications can occur. A typical side effect is the so-called "post-embolisation syndrome". This is the name given to a complex of symptoms often associated with nausea, pressure in the upper abdomen, pain, joint pain and sweating.3 For this reason, patients are usually admitted to hospital for two or three days.  Meanwhile, it is important that patients are closely monitored to detect and treat potential complications early.

When GPs see patients who should have or have had transarterial chemotherapy (TACE) for the treatment of primary or secondary liver tumours, they should pay attention to certain things to ensure appropriate follow-up and monitoring. Here are some important points:

  1. Checking medication intake: Before TACE, new oral anticoagulants (NOACs) should be discontinued at least two days before the intervention. After TACE, nausea and pain can last up to two weeks. Antiemetics as well as weak opiates may be prescribed in this case.
  2. Monitoring of complications: Possible complications of TACE include fever, nausea, vomiting and pain. GPs should regularly check the patient for such symptoms and treat them if necessary. If patients are taking anticoagulation, the groin region should be checked to detect possible bleeding or aneurysm track at the puncture site.
  3. Regular review of liver function tests: Liver function may be impaired after TACE. GPs should order regular blood tests (ASAT, ALAT, AP, GGT, albumin) to ensure that liver function remains stable.
  4. Monitoring long-term side effects: TACE can have long-term side effects, such as damage to surrounding tissue or organ systems. GPs should check lung function and blood glucose regularly.
  5. Coordination with the oncologist and interventional radiologist: It is important that GPs work closely with the oncologist and interventional radiologist to ensure the best possible care for the patient and to provide appropriate monitoring and follow-up.

In summary, TACE plays an important role in the treatment of HCC and is recommended by the European Guidelines as a possible treatment option. However, patient selection and monitoring of potential complications are crucial for the success of the treatment.

  1. In German: Zangos S, Gille T, Eichler K et al. Transarterielle Chemoembolisation bei hepatozellulären Karzinomen: Technik, Indikationsstellung, Ergebnisse. Radiologe 2001; 41: 906–914
  2. Zane KE, Nagib PB, Jalil S, Mumtaz K, Makary MS. Emerging curative-intent minimally-invasive therapies for hepatocellular carcinoma. World J Hepatol 2022; 14(5): 885-895
  3. Blackburn H, West S. Management of Postembolization Syndrome Following Hepatic Transarterial Chemoembolization for Primary or Metastatic Liver Cancer. Cancer Nurs. 2016 Sep-Oct;39(5): E1-E18. doi: 10.1097/NCC.0000000000000302.