Korean J Radiol.  2009 Oct;10(5):425-434. 10.3348/kjr.2009.10.5.425.

The Current Practice of Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma

• Shin SW

• KMID: 1093956
• DOI: http://doi.org/10.3348/kjr.2009.10.5.425

Abstract

Despite remarkable advancement in the surveillance and treatment of hepatocellular carcinoma (HCC) and the availability of novel curative options, a great proportion of HCC patients are still not eligible for curative treatment due to an advanced tumor stage or poor hepatic functional reserve. Therefore, there is a continuing need for effective palliative treatments. Although practiced widely, it has only recently been demonstrated that the use of transarterial chemoembolization (TACE) provides a survival benefit based on randomized controlled studies. Hence, TACE has become standard treatment in selected patients. TACE combines the effect of targeted chemotherapy with the effect of ischemic necrosis induced by arterial embolization. Most of the TACE procedures have been based on iodized oil utilizing the microembolic and drug-carrying characteristic of iodized oil. Recently, there have been efforts to improve the delivery of chemotherapeutic agents to a tumor. In this review, the basic principles, technical issues and complications of TACE are reviewed and recent advancement in TACE technique and clinical applicability are briefed.

Keyword

Carcinoma, hepatocellular; Chemoembolization, therapeutic; Iodized oil; Doxorubicin; Gelatin sponge, absorbable

MeSH Terms

Antineoplastic Agents/therapeutic use
Carcinoma, Hepatocellular/*therapy
Chemoembolization, Therapeutic/*methods
Gelatin Sponge, Absorbable/therapeutic use
Humans
Infusions, Intra-Arterial
Iodized Oil/therapeutic use
Liver Neoplasms/*therapy

Figure

• 

  Fig. 1 66-year-old man with hepatocellular carcinoma. A, B. Early (A) and delayed (B) phases of contrast enhanced CT scans show large mass (arrowheads) in right hepatic lobe. Note filling defect in inferior vena cava (arrow) that is tumor thrombus extending from right hepatic vein. C. Hepatic arteriogram shows infiltrative tumor staining in right hepatic lobe with formation of extensive arteriovenous shunt (arrowheads). Transarterial chemoembolization was performed with mixture of 15 ml of Lipiodol and 50 mg of doxorubicin followed by gelfoam embolization. This patient underwent four sessions of transarterial chemoembolization over period of five months. D. Five months later, follow-up angiogram shows almost complete disappearance of tumor vascularity and only trace of arteriovenous shunt is noted (arrowheads). E, F. One year later, follow-up CT scan shows shrunken tumors without any evidence of viable tumor. Size of tumor thrombus in inferior vena cava has markedly decreased as well (arrow in F). Initial serum level of αFP was 917.0 ng/ml and it returned to normal (2.6 ng/ml).

• 

  Fig. 2 56-year-old man with hepatocellular carcinoma. A, B. Contrast enhanced CT scans show two enhancing nodules (arrowheads) in liver segment 7 (A) and segment 8 (B). Serum αFP level was 5826.7 ng/ml. C. Hepatic arteriogram shows two hypervascular tumor nodules (arrows) in corresponding segments. Segmental transarterial chemoembolization was performed with mixture of 5 ml of Lipiodol and 20 mg of doxorubicin followed by gelfoam embolization. D. Post-transarterial chemoembolization plain radiograph shows better deposition of Lipiodol in portal vein around tumor in segment 7 (arrows) when compared to tumor in segment 8 (arrowheads). E. Follow-up CT scan one month later shows residual tumor enhancement in segment 8 (arrowheads). In contrast, CT reveals compact Lipiodol retention in tumor of segment 7 without evidence of viable tumor (not shown). Serum αFP level was 177.9 ng/ml. F. Hepatic arteriogram for second session transarterial chemoembolization shows tumor staining in segment 8 (arrows) in agreement with CT findings. No tumor staining is noted in segment 7 tumor. G. After subsegmental transarterial chemoembolization, Lipiodol deposition appears better in portal vein around segment 8 tumor (arrows) when compared with that of previous transarterial chemoembolization. H. Four months after second transarterial chemoembolization, follow-up CT scan shows compact Lipiodol uptake in both of tumors without any viable tumor portion. Serum αFP level returned to normal (2.9 ng/ml).

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