Cancer Treatment Today

Transcatheter arterial chemoembolization (TACE) of the liver is a proposed alternative to conventional systemic or intra-arterial chemotherapy, and to various nonsurgical ablative techniques, to treat resectable and nonresectable tumors. The rationale for TACE is that infusions of viscous material containing one or more antineoplastic agents may exert synergistic effects: cytotoxicity from the chemotherapy, potentiated by anoxia in the infarcted region. The beneficial effect of chemoembolization may be further potentiated by labeling the infusate with radioactive isotopes for localized radiotherapy. The liver is especially amenable to such an approach, given its distinct lobular anatomy, the existence of two (2) independent blood supplies, and the ability of healthy hepatic tissue to grow and thus compensate for tissue mass lost during chemoembolization. Another rationale is that TACE delivers effective local doses, while possibly minimizing systemic toxicities associated with oral or intravenous chemotherapy.

Trans Arterial Chemoembolization is often used for hepatocellular carcinoma and neuroendocrine cancers of the liver. The safety and effectiveness of chemoembolization for breast cancer metastases is unknown as only case reports and series have so far been reported. The largest series reported in a 2008 abstract was of 217 patients but this was not a prospective study.

The Society of Interventional Radiology (SIR, 2009) states that chemoembolization has shown promising early results with some types of metastatic tumors but that the evidence in the current medical literature is insufficient to demonstrate the efficacy of TACE or TAE for the treatment of liver metastases from other primary tumors, including but not limited to breast cancer, colorectal cancer, and other tumors of unknown primary sites, or, from ovarian cancer. Metastatic disease to the liver from tumors other than primary neuroendocrine tumors is generally treated with surgery, chemotherapy, or both.

Metastatic disease to the liver from ovarian cancer is somewhat less frequent than from breast cancer. A recent report from Vogl at al found that it is an effective palliative treatment in achieving local control in selected patients with liver metastases from ovarian cancer. It is the only study on this topic. This is similar to outcomes for the metastatic disease to the liver treated with TACE. Generally such results have not been thought to be adequate to recommend TACE ofr ovarian cancer because overall survival has not been increased.

Thomas J. Vogl et al, l Initial experience with repetitive transarterial chemoembolization (TACE) as a third line treatment of ovariancancer metastasis to the liver: Indications, outcomes and role in patient’s managementGynecologic Oncology Volume 124, Issue 2, February 2012, Pages 225–229

M . Giroux , R . Baum , M . Soulen. Chemoembolization of Liver Metastasis from Breast Carcinoma . Journal of Vascular and Interventional Radiology , Volume 15 , Issue 3 , Pages 289 – 291, 2004

Brown DB, Geschwind JF, Soulen M, et al. Society of Interventional Radiology (SIR) position statement on chemoembolization of hepatic malignancies. Society of Interventional Radiology. J Vasc Interv Radiol. 2006; 17(2):217-223.

Alexander T. Ruutiainen et al, Chemoembolization and Bland Embolization of Neuroendocrine Tumor Metastases to the Liver Journal of Vascular and Interventional Radiology Volume 18, Issue 7, July 2007, Pages 847-855

Society of Interventional Radiology (SIR). Interventional radiology treatments for liver cancer. 2009. Available at: http://www.sirweb.org/patients/liver-cancer/

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