TACE for Liver Metastases from Ovarian Cancer

Transcatheter arterial chemoembolization (TACE) of the liver is an alternative to conventional systemic or intra-arterial chemotherapy, and to various nonsurgical tumor-killing techniques. It is meant to treat resectable and non-resectable tumors. The rationale for TACE is that infusions of viscous material containing one or more chemo drugs may have synergy: chemotherapy killing cancer cells that are already weakened from a lack of oxygen in the area. Synergy can be further potentiated by attaching radioactive isotopes for localized radiotherapy. The liver is especially amenable to such an approach, given its unusual anatomy, the fact that it is fed by two main and independent blood sources, and the ability of healthy hepatic tissue to recover from chemotherapy and re-grow damaged cells and thus compensate for cells lost during chemoembolization, whereas the cancer cannot do so. Another rationale is that TACE delivers effective local doses, while minimizing systemic toxicities that can be caused by oral or intravenous chemotherapy.

Trans Arterial Chemoembolization is often used for hepatocellular carcinoma and neuroendocrine cancers of the liver. However for other types of cancer, less information is available.  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) stated 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 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, 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 TACE 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 of ovarian cancer because overall survival has not been increased.

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