Cancer Treatment Today

According to the NCCN, determining whether or not TACE is indicated involves a process of elimination. On the one hand, TACE is not as effective as surgery (either transplant or partial hepatic resection) for curing HCC or metastatic disease and is not in and of itself considered to be a curative treatment. On the other hand, TACE is a more effective treatment than others on the spectrum of treatments that may be considered to be purely palliative. In a minority of situations, TACE either can change a patient’s status from “incurable” to “curable” (by downsizing one or more tumors to qualify the patient for surgery) or provide complete permanent tumor necrosis. Thus, on the one hand, a candidate for TACE is someone who has such advanced tumor status and/or overall poor health so as not to be able to withstand surgery or to gain a survival benefit from it as a first line option. This same person, on the other hand, must be healthy enough to withstand the potential side effects and toxicity of TACE and to have good enough odds of gaining at least several months of additional survival at a reasonable quality of life.

AFRQ in 2011 stated: ” Guidelines from the National Comprehensive Cancer Network for metastatic CRC state that ablative therapy for the metastases can be considered when all measurable metastatic disease can in fact be treated. However, the group provides no guidance on which ablative therapy is optimal or on the comparative benefits and harms of the various palliative treatments. A perception of clinical equipoise and limited randomized controlled trial (RCT) data comparing local hepatic therapies31,32 contribute to uncertainty regarding which techniques, either alone or in combination, may be preferable for certain patient groups.”

There are only scattered case reports and series for TACE used for liver metastases. The report by Azziz of ONLY 32 cases concluded: “ Repetitive TACE resulted in a relevant response for the control of liver metastases of pancreatic cancer with respectable median survival time. Interestingly, the number of lesions, statistically, was not an effective factor.” TACE is not included in the SEOM guideliens for metastatic pancratic cancer.

AHRQ – http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1354&pageaction=displayproduct, 2011

Azizi A, Naguib NN, Mbalisike E, Farshid P, Emami AH, Vogl TJ. Liver metastases of pancreatic cancer: role of repetitive transarterial chemoembolization (TACE) on tumor response and survival. Pancreas. 2011 Nov;40(8):1271-5.

Mª A. Gómez España et al, SEOM clinical guidelines for pancreatic and biliary tract cancer (2020) Clinical and Translational Oncology https://doi.org/10.1007/s12094-021-02573-1