Dr. Fong is the Medical Director of the USC Liver Transplant Program and Associate Professor of Medicine at the USC Keck School of Medicine. He obtained his medical degree from the University of Southern California and completed his residency in Internal Medicine at Los Angeles County-USC Medical Center. He is board certified in Internal Medicine and the subspecialty of Gastroenterology.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Arterial chemotherapy infusion of the liver and chemoembolization of the liver (transarterial chemoembolization or TACE) are similar procedures that are used for the treatment of cancers in the liver. In both procedures, chemotherapy is injected into the hepatic (liver) artery that supplies the liver tumor. The difference between the two procedures is that in chemoembolization, additional material is injected to block (embolize) the small branches of the hepatic artery.
Why is the chemotherapy injected into the hepatic artery?
The normal liver gets its blood supply from two sources: the portal vein (about 70%) and the hepatic artery (30%). Primary liver cancer, also known as hepatoma or hepatocellular carcinoma (HCC) gets its blood exclusively from the hepatic artery. These techniques can be used to treat secondary, or metastatic liver cancer, which is cancer that spread to the liver from other primary sites. These metastases also draw their blood supply from the hepatic arteries. This discussion will focus on primary liver cancer. Making use of this pattern of blood supply, investigators have delivered chemotherapy agents selectively through the hepatic artery directly to the HCC tumor. The theoretical advantage is that higher concentrations of the agents can be delivered to the cancer. The technique takes advantage of the concept of extraction: toxicity can be reduced by relying on the liver to extract or break down some of the chemotherapy after the tumor has been exposed to it before the chemotherapy gets through the liver into the systemic circulation.
What are the side effects and benefits of arterial chemotherapy infusion?
In reality, however, depending on the chemotherapeutic agent used, much of the drug does end up in the rest of the body. Therefore, selective intra-arterial chemotherapy can cause the usual systemic (body-wide) side effects. In addition, this treatment can resultin some regional side effects, such as inflammation of the gallbladder(cholecystitis), intestinal and stomach ulcers, and inflammation of the pancreas(pancreatitis). HCC patients with advanced cirrhosis may develop liver failure after this treatment. So, what is the benefit of intra-arterial chemotherapy? The bottom line is that there is a greater likelihood of having a therapeutic effect on the cancer. Nevertheless, fewer than 50% of HCC patients will experience a reduction in tumor size.
The treatment chosen depends upon how much the cancer has spread and the general health of the liver. For example, the extent of cirrhosis (scarring) of the liver can determine the treatment options for the cancer. Similarly, the spread and extent of spread of cancer beyond the liver tissue plays an important part in treatment options.
Chemotherapy: Chemotherapy uses a medicine that kills cancer cells. The medicine can be given by mouth or by injecting it into a vein.