Transarterial chemoembolization for hepatocellular carcinoma - New developments

Transarterial chemoembolization (TACE) is a generic term for a whole range of various interventional procedures. The common principle is a catheter-based transarterial administration of cytotoxic substances which are bound to embolizing carrier substrates and, therefore, lead to prolonged capillary transit time of the therapeutically active agents and give rise to local hypoxia in the tumor. TACE profits from the fact that hepatocellular carcinomas are predominantly perfused by arteries, whereas normal hepatocytes are predominantly supplied via the portal vein (approximately 70-80%). The principle of TACE is to use this difference in vascular supply to enable a selective therapy of hepatocellular carcinomas with maximum protection of the healthy or non-tumor bearing liver tissue. The various TACE procedures differ substantially with respect to the choice of chemotherapeutic agent, choice of the embolizing substances and of the angiographic approach (i.e. the selectivity of the transarterial administration). This procedural flexibility allows selection of an approach adjusted to the individual patient's situation in terms of tumor stage, and liver reserve. Because of this therapeutic range, TACE can be applied to adjuvant or palliative treatment of patients in BCLC stages 0, A, B and C, whereby the respective aims of treatment and the respective technical approach for TACE differ with BCLC stage. Current developments include innovative embolizing carrier substrates (drug-eluting beads), new formulations of established substances (in particular lipiodol-ethanol ablation), the use of the β-emitter yttrium 90 in place of chemotherapeutic agents within the framework of radio-embolization as well as a combination of transarterial and local ablative procedures (TACE-RFA). © 2009 Springer Medizin Verlag.